As many low- and middle-income countries (LMICs) pursue health care reforms in order to achieve universal health coverage (UHC), development of national accreditation systems has become an increasingly common quality-enhancing strategy endorsed by payers, including Ministries of Health. This article describes the major considerations for health system leaders in developing and implementing a sustainable and successful national accreditation program, using the 20-year evolution of the Thai health care accreditation system as a model. The authors illustrate the interface between accreditation as a continuous quality improvement strategy, health insurance and other health financing schemes, and the overall goal of achieving universal health coverage.
Many low- and middle-income countries (LMICs) are currently pursuing health care reforms to achieve universal health coverage (UHC); however, gaps in health care quality threaten this objective [1,2]. Despite serious resource limitations, there is a growing belief that strengthening health care quality in LMICs can have an important impact on the efficiency, security, and responsiveness of health services, as well as support expansion efforts towards the goal of achieving UHC [3,4]. A 2012 Salzburg Global Seminar convened health leaders from 33 countries to review experiences and identify priority challenges in ensuring healthcare quality and safety in LMICs. The Seminar developed a consensus statement that calls for governments to adopt and promote quality improvement as a cornerstone for better health for all citizens . LMICs have thus rightly sought health systems reforms that not only improve health care coverage but also seek to improve the overall quality of health care services—something we refer to as "universal quality coverage" .
The Joint Learning Network (JLN) for Universal Health Coverage is an international consortium of countries implementing health financing reforms aimed at accelerating peer-to-peer knowledge and experience sharing . Nine countries in Africa and Asia are members of the JLN network: Ghana, India, Indonesia, Kenya, Malaysia, Mali, Nigeria, the Philippines, and Vietnam. In 2011, the JLN established a health care quality track which published a summary of methods available to improve health care quality within UHC schemes, including accreditation  All nine of the JLN countries either have accreditation schemes or are developing them. At a JLN meeting in Bangkok, Thailand, in April 2013, representatives from all countries shared lessons learned from their accreditation efforts and issued a request for a concise policy document that would offer guidance to country-level decision makers regarding important technical questions that commonly surface.
This document supports future policy development and answers some of the recurrent questions often heard from policy makers, payers and health system leaders: how can accreditation create a culture of continuous quality improvement; what are the key technical choices within accreditation systems and what does the international evidence and experience recommend; what is the role of health care insurance in accreditation; and how can accreditation efforts be leveraged to guarantee basic services in poor and remote communities?
We take these questions in turn, and in each case we summarize the issues and provide the best evidence where possible as it may exist from international sources. There are four sources of information for this evidence: the presentations and proceedings of the April 2013 JLN conference in Bangkok; a review of the literature on accreditation, particularly as it references experience in LMICs; and grey literature and non-peer reviewed source information from leading advocacy and expert organizations like World Health Organization (WHO) and the International Society for Quality in Healthcare (ISQua). Finally, where the data from these other sources were limited, we supplement with the authors' own experiences from the field. Throughout this document we use ISQua's definition for accreditation: "A public recognition by a healthcare accreditation body of the achievement of accreditation standards by a health care organization, demonstrated through an independent external peer assessment of that organization's level of performance in relation to the standards" . We also use the WHO's definition of UHC: "ensuring that all people can use the promotive, preventive, curative, rehabilitative and palliative health services they need, of sufficient quality to be effective, while also ensuring that the use of these services does not expose the user to financial hardship" .
Although important, accreditation is often just one of a number of quality improvement and evaluation strategies, so differentiating it from other regulatory or evaluation mechanisms is essential. Licensure is generally considered a government regulatory responsibility, designed to set minimum standards to protect the health and safety of the public. Licensing authorities such as Ministries of Health have the authority to determine which provider organizations can operate, levy fines for deficiencies and, in some cases, even close a substandard provider.
Accreditation, on the other hand, sets standards that are considered optimal and achievable, more rigorous than the minimum standards of licensure, and with a stated intent to foster a culture of improvement. In many countries, accreditation is a voluntary recognition program and administered separately from the Ministry of Health, often by a Non-Governmental Organization (NGO) or a quasi-regulatory agency with support and recognition—but at an "arm's length"—from the government. However, a study by Braithwaite et al. comparing health service accreditation in LMICs with those in higher income countries found that in 60% of respondents from twenty LMICs, accreditation is managed within the Ministry of Health. This is a rare occurrence (only 8% of respondents) in higher income countries. The researchers hypothesized that such a differentiation reflects both a national response to resource limitations in LMICs and an effort to ensure sustainability . Even if administered independently from the Ministry of Health, it is important to note that the accreditation body plays a vital role in advancing the Ministry's overall quality and safety agenda.
Legislation to establish the legal structure and scope of the accrediting body is an important first step which can ensure the sustainability of the accreditation program. The survey profile of 44 global accreditation organizations (AOs) published by Shaw et al. in 2013 demonstrated that two-thirds of responding AOs were formally authorized by national legislation, official decree, or both. Government strategies tended to be associated with legislation. Those that were not formally authorized by law tended to be the larger, more mature AOs, such as in Australia, USA, England, and South Africa, which were originally organized as independent Non-Government Organizations (NGOs) . Regardless of whether it is mandated by legislation, there should be a legal charter, articles of incorporation, or bylaws that clearly describe the role of the accrediting body, its governance, scope of responsibility and authority, and relationship to government oversight of quality. For example, will the government licensing agency accept an accreditation award in lieu of doing its own evaluation? Will the accreditation program be mandatory or voluntary? Many countries have opted for a voluntary approach to accreditation, thus differentiating it from licensure (mandatory) and intending it to recognize a higher level of achievement. Regardless, there should be close collaboration between the licensing agency and the accreditation body, in order to reinforce compliance with regulatory requirements and better enable sustainability of the AO [13-17].
Governance of the accrediting body frequently represents a credible cross-section of health care professionals (such as professional societies, medical or nursing boards), the public at large, and other stakeholders such as financing agencies, industry, NGOs, and/or academic institutions. The international survey of AOs by Shaw et al. reflected a preponderance of healthcare clinicians, especially physicians, in governance roles. Government regulators were represented in approximately half of the responding AOs, while insurers and patients and families were represented in about a third of the 44 responding AOs . In order for the eventual accreditation award to be credible, the governing body's objectivity must be above reproach. Therefore, any potential conflicts of interest must be addressed up front through rigorous governance screening and selection, policies, and codes of ethical conduct.
The heart of any accreditation program lies in the reliability, validity, measurability, and objectivity of its standards. Accreditation standards must encourage improved performance, while at the same time being achievable and not overly prescriptive. An excellent framework for guiding the standards development process is available free of charge from ISQua through its recently revised International Principles for Healthcare Standards.
Standards development typically begins with a thorough literature review to assess the current set standards from within the country (e.g., licensing, food and drug safety regulations, building and fire codes), as well as other national programs or global accreditation organizations. A 2009 study of 18 European accreditation organizations demonstrated a movement from a traditional collegial model of accreditation toward more of a semi-regulatory model that incorporates minimal licensing and public safety standards with aspirational standards for continuous improvement . The standards should address all critical elements of quality and safety in the specific health care provider category, including patient care processes such as assessment and treatment, medication management and safety, infection prevention, blood usage, diagnostic services such as laboratory and radiology, anesthesia and surgical services, patient education, and continuity of care. In addition, critical management components must be addressed, including governance and leadership, financial management, staff credentialing and human resource management, building safety, patient rights and ethics, medical records and information management, and quality and safety management. Wherever possible, the accreditation program should engage subject matter experts in the development and review of new or revised standards. One approach is to use advisory structures that function in a "virtual" environment, through electronic document review and videoconferencing [18,20].
Before the draft standards are finalized, it is critical to seek stakeholder feedback from as many sources as possible, including providers, health care professional societies, the public, employers, and consumer advocacy groups. This process of stakeholder engagement helps to ensure that the final version of the standards will be seen as credible, understandable, and rooted in good clinical and management practices. We recommend a pilot test of any new standards at a sampling of provider organizations. The pilot should use an objective on-site survey or evaluation process, to confirm that the standards can be measured in a comprehensive, reliable, and consistent manner. Adjustments can then be made to the standards or survey process before the final standards are launched. Periodic revision is also important. The ISQua standards require a thorough standards review and revision process at least every four years.
Leadership of an effective accreditation program includes operational management; surveyor selection, training, credentialing, and ongoing supervision and support; operating policies and procedures; design and implementation of a credible and objective evaluation process that includes sampling criteria; the application, staffing, and scheduling processes for conducting the on-site survey; field education to providers in the standards, evaluation process, and quality improvement strategies; financial management; and information management . The challenges to successful program management in resource-limited settings are considerable. For example the challenges may range from corruption to poor information management (thus making data collection and evaluation especially difficult) to knowledge gaps about quality and safety among health care workers to difficulties in surveyor travel to remote settings of healthcare delivery. Research by Sax and Marx of accreditation development in one province in Pakistan demonstrated that a major challenge was the establishment of a well-managed, transparent accreditation agency able to lead processes such as training and support for peer surveyors. This study also identified that an understanding of local change mechanisms and cultural practices is important in designing a sustainable accreditation approach .
Well-trained, knowledgeable, and objective surveyors are critical to the design of any successful accreditation program. Among the 20 LMIC countries represented in the Braithwaite et al. survey of global accreditation organizations, almost 90% indicated they have instituted a process by which surveyors are formally certified after successful completion of training . In addition to their knowledge of the standards and evaluation processes, surveyors must possess a high degree of personal and professional integrity as well as an ability to teach, inspire, and motivate provider organizations to a high level of performance. If surveyors are viewed as biased or punitive, the goal of the accreditation program in stimulating a culture of improvement will fail. Some accreditation programs have added a public or consumer representative to the evaluation team, with a particular focus on how the provider organization addresses patient needs such as wait times, food quality, privacy, and patient rights.
Valid data are also essential, thus warranting the design of an efficient and effective data collection and management function. This function must include the initial application for accreditation, the profile of the institution to be accredited, the on-site survey findings, other indicator data, as well as the accreditation decision itself.
When the accreditation program captures data about provider performance during the on-site evaluation, this data can be used not only to make assessments about the individual provider over time, but can be aggregated to give a national view as well. This aggregate performance data can inform larger health policy decisions, funding, and education. For example if the aggregate hospital accreditation data reveals a systemic problem with antibiotic overuse and misuse at a national level, policy changes might modify he national formulary and develop consistent clinical policies for appropriate antibiotic stewardship throughout the country.
Valid, reliable, and transparent decision criteria should be employed in making the determination of an accreditation award, so that the "rules" are known and understood by all and the credibility of the accreditation program is supported. The criteria and the threshold for achieving accreditation should aim to both recognize outstanding performance and differentiate weak performance, while still motivating provider organizations toward a culture of continuous improvement. Some accreditation programs do that through implementing a tiered or "step-wise" approach to accreditation along an improvement continuum. The accreditation award is typically renewed via a process of an on-site survey every 2–4 years.
The criteria must also address what happens when an accredited provider experiences a significant quality or safety incident, changes ownership, or embarks on a major construction project. If the accreditation program withdraws accreditation for some reason, under what circumstances can the provider reapply? The accreditation program's policies should specify if, and how, the results of the accreditation award will be made public and/or reported to the Ministry of Health. This is especially critical in those cases where the surveyors identify a serious threat to public health or safety. The accreditation program typically does not have the legal authority to close a facility, whereas the Ministry of Health could do so in those rare circumstances.
Accreditation, because it involves an "external peer review" that is intended to place a value judgment on the quality, safety, and cleanliness, of an institution, has often been regarded as a form of summative evaluation rather than a mechanism for formative learning. However, as described in the developmental milestones of Thailand's Healthcare Accreditation Institute (Table 1), accreditation ideally should mature towards a more formative, continuous learning environment.
Pilot project of TQM in public hospitals to learn how quality improvement tools and concept can be applied to health care.
Development of first hospital accreditation (HA) standards, continuous quality improvement concept being incorporated.
Standards implementation as a research and development project, emphasized a multidisciplinary team approach. Lab and pharmacy standards are used.
First National Forum on Quality Improvement and Accreditation is held, and continues annually as a forum for experience sharing and updating knowledge.
Institutionalization of the project, The Institute of Hospital Quality Improvement and Accreditation (HA) was founded under the umbrella of the Health Systems Research Institute.
The Universal Health Coverage (UHC) policy launched in Thailand, setting the expectation for a quality health care system.
The HA program started a stepwise recognition program to gain acceptance and expand coverage, encouraging continuous improvement considering potential and limitation of each hospital.
Health Promoting Hospital (HPH) standards and accreditation program were developed.
First HA Patient Safety Goals were developed and instituted.
Integration of HA & HPH standards, using National Quality Award framework.
Introduction of standards addressing spirituality into quality improvement.
The HA/HPH Standards were accredited by ISQua.
The accreditation body was transformed to be The Healthcare Accreditation Institute (Public Organization), an autonomous government agency.
Quality Learning Networks, empower accredited hospitals to give assistance to their peer hospitals.
Community of Practice for high-risk services.
Sustainability of accreditation is largely dependent on sufficient financing, not only for the initial development costs, but for ongoing governance and operations, surveyor training and management, education to provider organizations, and potentially, to make needed improvements within the provider organizations themselves. Therefore, it is useful to project a 5-year financing plan; for example, the initial (years 1 and 2) development costs may be supported by the Ministry of Health or by a donor or funding agency, but after launch, ongoing financial viability will need to be carefully considered. Will the provider organizations be assessed a fee for the accreditation visit and related travel expenses? Especially in the start-up phase when there are a smaller number of participating providers, how will these fees support ongoing operations until the program becomes self-sustaining? Fees generated from related education programs are often a good revenue source to support the operations of the accreditation body. Still, Shaw et al's survey of 18 European accreditation organizations in 2009 identified that the size of the country's population and thus number of potential accreditation customers can have a significant impact on the long-term viability of the accreditation operation. After initial start-up funding, the ongoing operations will need to be supported by institutional customers, and in a country with a small number of healthcare provider organizations, these costs can be considerable .
In addition to the financial support to the accrediting body, it is also critical to consider how provider organizations will be supported in their accreditation and improvement efforts. For example, how will needed improvements which involve capital costs such as facility renovation or the purchase of large equipment be addressed? Without this consideration, the accreditation program runs the risk of irrelevance, as it promotes standards and expectations that are not achievable. Some countries have found it helpful to secure external funding support for at least 4–5 years as the accreditation program is developed and launched. Financial support can even extend to education and technical assistance to pilot groups of provider organizations that serve as demonstration projects and models for meeting the standards.
In order for health care leaders and professionals to embrace the philosophy of accreditation, they must view it as making a discernible difference in quality and safety as well as a sound business decision. For the former, data on valid indicators such as infection rates and maternal mortality – from baseline through the entire improvement and accreditation journey – can engage clinical leaders and staff who are motivated by a genuine interest in attaining improved outcomes. An international survey of 44 global accreditation organizations found that more than 80% indicated "quality improvement" as the primary motivator for accreditation, although commercial incentives and benefits also played an important motivating role .
Linking accreditation to securing favorable bank loans and payment terms as well as other forms of recognition such as reimbursement differentials, participation in insurance schemes, "preferred provider" status from employers, and designation as medical travel destinations have been effective mechanisms for making the "business case" for accreditation [24-26]. The 2009 survey of European accreditation organizations, discovered that "the uptake and stability of voluntary accreditation are largely dependent on tangible commercial advantage to accredited institutions, either by increasing market share or by direct funding" . In India, the CGHS (Central Government Health Scheme) has made provision to provide 15% more remuneration to hospitals accredited by the National Accreditation Board for Hospitals and Healthcare Providers (NABH) .
Increasingly, insurers and employers are relying on an objective and credible accreditation award as a prerequisite for provider participation in their health care reimbursement programs. In some instances this is called "empanelment", to represent a standard/criteria driven process whereby providers are selected to participate in the insurance program. This is frequently done in lieu of the insurer or employer conducting its own on-site evaluation or performance data collection and analysis. Examples include India, Brazil, and Costa Rica . In these situations, while accreditation remains a voluntary process, the financial incentives can be powerful enough that it becomes "quasi-mandatory" and seen as essential to good business for a successful and reputable health care provider. Some employers and insurers – even some government payers -- provide extra motivation by rewarding good performance with a higher reimbursement rate as compared to unaccredited providers .
Ideally, the insurer or payer would recognize the considerable achievement of performance that accreditation represents and would not duplicate or contradict prevailing national accreditation standards or data collection requirements through its own quality evaluation criteria. That creates a useful symbiosis whereby the insurer or payer can justifiably rely on an objective third party (the accreditation body) for a credible evaluation, and the provider in turn is motivated to continuously improve its performance by virtue of receiving the financial benefit of receiving new patients with insurance coverage. This virtuous cycle points to the need for the accrediting body to engage insurers and payers at the front end of the development process, as well as to secure their buy-in and support for the sustainability of the accreditation program. Many mature accreditation organizations now offer some degree of "regulation by proxy", as a third party assessor of compliance with regulation on behalf of a government or payer, thus reducing the burden of inspection by multiple bodies .
Insurers can also play a critical role in data and knowledge sharing with the accreditation program, in the forms of guidelines, protocols, tools, and aggregate data on provider performance. Many insurers and corporations will help to fund educational programs and resources about the accreditation standards, quality, and safety, and thus can become strong allies in supporting accreditation in a country.
A common question at the start of any accreditation development initiative is often, "Can one size really fit all?" In other words, is it possible to develop a single set of standards which apply to a common provider type (e.g., hospital, clinic, clinical laboratory) within a country, ranging from a large tertiary hospital to a small and rural district facility? Some countries and programs have used a progressive and step-wise approach to accreditation for all providers, starting first with more basic structural standards for hand-washing and facility safety and then "raising the bar" with more complex and outcome-focused standards. If this approach is adopted, it is useful to communicate an overall plan for the kind of standards progression and expected timeframes for achievement (e.g., more progressive standards will be introduced every 2–3 years). That way all providers will understand this up front as both encouraging and expecting improved performance over time. The public recognition given to achieving even the most basic level of performance at the start of the national accreditation system can be a valuable building block in creating a national culture of quality improvement. The case study in Table 2 highlights some of the lessons learned from the national improvement journey in Thailand.
Make it voluntary. Offer opportunities for doctors and hospitals to participate; don't tell them that it is mandatory.
Focus on coaching/learning, not inspection/audit. Don't focus too much on pass/fail, but instead, what needs to be done to improve.
Focus also on knowledge activities (e.g., large Thai annual quality educational meeting).
Use recognition of hospital staff as well as offer opportunities to optimize their potential.
Have payer organizations provide incentives (e.g., health insurance and social security pays more to accredited hospitals).
Treat the organization/hospital as living system - self-organizing, learning.
Another approach to address basic levels of quality improvement, especially in smaller and resource-poor facilities, is to develop an accreditation system that takes into account that not all providers will ever be able to meet the same set of standards. In the U.S., this approach is seen with Critical Access Hospitals, providers in rural areas with a licensed capacity of 25 beds or less; these hospitals are required to meet a different, less complex set of standards than their tertiary care counterparts . Some accreditation programs around the world use a common set of basic standards for all, and then add standards components for complexity and specialization, such as for pediatric or psychiatric hospitals.
A third approach to progressive accreditation can be in the design of the accreditation program, both in its standards as well as its criteria and threshold for achieving accreditation. For example, a single standard for implementing an infection control program may receive an entry-level score when the provider implements a required structure such as a policy or procedure, and then progress to a full accreditation status when its infection control program is fully implemented and demonstrates through its data that it is effective in controlling infections. This approach adopts a Structure-Process-Outcome framework to improvement by recognizing the beginning steps of implementing structures such as policies or committees, yet motivates and stretches providers to achieve an even higher level of performance.
The true goal of UHC schemes is to provide universal access to high-quality health care services. This "universal quality coverage" will only be realized if quality-enhancing mechanisms like accreditation can be successfully implemented in LMIC settings. To date, efforts to depict how UHC scheme will work have focused on three dimensions: expanding coverage, describing the benefits covered and financial risk protection that the coverage scheme offers. Descriptions of the quality of care that the coverage scheme offers has not been well addressed. We propose a new image moving from the model proposed in the WHO Report on UHC to the model shown in Figure 1 where coverage, benefits and financial risk protection are all represented as overlapping and expanding balloons. They reach outwards through gradations of quality of health services represented by the dashed lines towards the outer limit of high quality health care services.
Four dimension of universal quality coverage.
Accreditation is among the most important strategies LMICs utilize to improve quality of care. The guidance provided in this paper is intended to assist governments, health system planners, and decision makers to make useful investments in accreditation or other quality-enhancing strategies as they pursue UHC. No two countries will be alike and thus, the important choices described above will vary from one context to the next.
No matter what type of accreditation design is pursued, the results from the external peer-review process should be fed into a continuous improvement effort that allows institutions to remediate gaps in structures, processes and outcomes and to ensure that where patterns in health system defects are recognized (as in the antibiotic overuse example described above), national-level action can be taken to improve care.
Accreditation and health system financing for universal coverage have the potential to be particularly reinforcing if deployed correctly. At the most basic level, payers for UHC could reinforce accreditation standards by providing the needed financial incentives to institutions to seek accreditation. In turn, accreditation can provide payers with the independent third-party evaluation of health care quality that they need to make sound decisions about which institutions and professionals to include in their reimbursement schemes. (Figure 2) On the other hand, lack of coordination between them will lead to confusion in the marketplace about which standards and protocols to follow, which measures or indicators to report, and which incentives to follow.
Reinforcing relationships between accreditation, financing and providers.
Achieving "universal quality coverage" will require alignment between government, payers and accreditors. There are many choices that opinion leaders, policy makers, and regulators face as they design health care systems to ensure high-quality service. This paper reviews some of the better practices that are available; however, much remains unknown about the role and ideal design of accreditation systems that will accelerate achievement of universal quality coverage. By identifying the gaps in our understanding, we hope to not only inform decision makers but also researchers interested in pursuing further study to help bring clarity to the field.
KM and AR participated in the study design and analysis, carried out the research, and participated in the drafting and revision of the manuscript. AS and GG participated in the study design and analysis and participating in drafting sections of the manuscript. All authors read and approved the final manuscript.
The authors would like to thank attendees at the Bangkok meeting for their contributions. Jane Roessner, Val Weber, Helen Smits, and Gina Lagomarsino provided invaluable advice, review, and contributions to this manuscript. Chris Rooney provided invaluable assistance to design of the figures and graphics. The Rockefeller Foundation provided funding for the Bangkok meeting described in the paper via a grant to the Institute for Healthcare Improvement.


Location: Piter Inn Petrozavodsk is perfectly located in the city centre next to the railway station and provides easy connections to all city districts. The hotel is also in proximity to city tourist attractions, shopping and business areas.
Hotel facilities: restaurant, cafe, 5 conference halls, gym, luggage room, parking lot.


Glencore has confirmed that production at its New South Wales West Wallsend underground coal mine has been halted due to "geological issues experienced on the current longwall operation last week".
A spokesperson for the mining company said they are investigating a number of options to resume operations as quickly as possible.
"However, it is expected that production could be affected for some time," the spokesperson said.
Glencore announced in May that mining at West Wallsend would be completed next year, consistent with the life-of-mine planning.


LED lighting has become an incredibly popular lighting source over the years due to the huge number of benefits they offer. LED light bulbs are semiconductor devices which efficiently convert electricity into light without the use of fluorescent tubes or filaments. LED light bulbs are incredibly energy efficient, able to convert over 80% of their energy to make light. When compared to incandescent bulbs, which give off over 80% of their energy as heat, LED bulbs are truly energy efficient.
This infographic from Efficient Light explores all of the key benefits of LED light bulbs when compared to incandescent and halogen bulbs.


These two organizations, College Board and Khan Academy, are working together to prepare students for the SAT! Follow the steps below.
Step 2: Use the information below if needed.
If prompted, agree to link your Khan Academy and College Board accounts.


This post is in English to welcome the new coworking space Nomadz, in The Hague, Netherlands… welcome to the community!
All the best to our Dutch friends, whose link is now in our coworking blogroll as well.
So… if anyone will be in the Netherlands, don't forget that this coworking spot in The Hague (and please say hi from Cowo Milano!).
Domande sul coworking, dal nostro Linkedin group.
Nuovo indirizzo internet, nuovi muri, vacanze.


text:
Week 12 Preview
Author: Jared Woodcock Published Date: November 14, 2018 Leave a Comment on Week 12 Preview
The production of Ian Book will be key in the Irish trying to stay undefeated against Syracuse. (Photo Courtesy: Michael Caterina/South Bend Tribune
Buffalo vs Ohio, 7:00 PM ET, ESPN2
This was setting up to be a championship game in the MAC East up until Ohio laid an egg last week and lost to a previously 3-6 Miami (OH) team by a score of 30-28. Buffalo is currently sitting at 9-1 and if they can go in and win this game on the right shoulder of Tyree Jackson and the dangerous running back duo of Jaret Patterson and Kevin Marks, they're looking at possibly being in the top-25 next week.
Pick: Buffalo
USF vs Temple, Noon ET, ESPNNews
USF has really struggled recently having lost three in a row after a 7-0 start and Temple is playing a lot better after a win over Cincinnati and Houston in the last three weeks and a game in which they challenged UCF, but came up short. With the way these two teams are playing and with it being a home game for Temple, it has me really favoring Temple.
Pick: Temple
(12) Syracuse vs (3) Notre Dame, 2:30 PM ET, NBC
This is the biggest of the two tests remaining for Notre Dame in their quest for an undefeated season and this is a big one because Syracuse has been playing really well. Notre Dame is still the better team and if they come in and play well and if Ian Book is able to play at the level he was playing at before missing last weeks game against Florida State, the Irish should be able to get a win, but that Syracuse offense will have something to say about that. This should be a really fun one in Yankee Stadium to see if Notre Dame can pass one of their last tests to try and get to the finish line of an undefeated regular season.
Pick: Notre Dame
Virginia vs Georgia Tech, 3:30 PM ET, ACC Network
A couple weeks ago this looked like a game that nobody should care about, but the way that things have been playing out in the ACC Coastal, this has become an important one, especially for Virginia, who is only a game behind Pitt in the division and already has a head-to-head loss against Pitt. Defending the triple option at this point in the season is always tough, especially with the way that Georgia Tech has been playing recently, but I think Virginia will go in and get a good road win on the backs of their defense.
Pick: Virginia
UAB vs Texas A&M, 7:00 PM ET, ESPN2
It's the annual late season bye, non-bye week for SEC teams and this is the most interesting of the matchups. UAB is a really good Conference USA team and I think they could give the Aggies some issues and keep this game competitive, but ultimately the Aggies will have too much talent and that will eventually win out.
Pick: Texas A&M
Duke vs (2) Clemson, 7:00 PM ET, ESPN
The Blue Devils have been kind of an up and down team this season, but they have won two in a row and are sitting at 7-3 on the season. If they are able to get off to a nice start they could possibly go into Death Valley and keep things interesting, but Clemson is playing as good as anyone in college football right now so I ultimately think Clemson will pull away in this one.
Pick: Clemson
(16) Iowa State vs (15) Texas, 8:00 PM ET, Longhorn Network
After a sluggish start to the season, Iowa State has been playing really well since they inserted Brock Purdy into the lineup at quarterback. They're playing much better than Texas at the moment, but going on the road to Austin will not be easy one bit, especially with star running back David Montgomery being suspended for the first half of this game after being involved in a brawl in the teams' win last week over Baylor. I believe having Montgomery out for the first half and having a freshman quarterback on the road against one of the better defenses in the conference will be a tough ask and the Longhorns will get things rolling again behind the good play of Sam Ehlinger.
Pick: Texas
(24) Cincinnati vs (11) UCF, 8:00 PM ET, ABC
College Gameday is making it's way to Orlando for this one! And it's not too hard to see why. UCF hasn't lost a game in two seasons and if you haven't seen Cincinnati play yet this season, they play really physical and really disciplined. They also run the ball really well on the back of Michael Warren II. The Bearcats are more than capable of beating UCF, but I think with Gameday being in Orlando and with this being a prime time game, UCF will want to make a statement and they'll go out and get a ranked win.
Pick: UCF
San Diego State vs Fresno State, 10:30 PM ET, CBS Sports Net
Both of these teams are coming off of rough losses. The Fresno State loss wasn't as bad of a loss as they lost last Friday at Boise State, but San Diego State lost at home to UNLV and that was a bad loss. I think Fresno State is still one of the two best teams in the Mountain West along with Utah State and I think they'll have a bounce back performance and the offense will be too much for a limited San Diego State offense.
Pick: Fresno State
Tagged Buffalo Football, Cincinnati Football, Clemson Football, Duke Football, Fresno State Football, Georgia Tech Football, Iowa State Football, Notre Dame Football, Ohio Football, San Diego State Football, Syracuse Football, Temple Football, Texas A&M Football, Texas Football, UAB Football, UCF Football, USF Football, Virginia Football
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redpajama_set_name: RedPajamaCommonCrawl


In "The Hum" we explore the idea of computers that communicate ephemerally through alterations of room and space. By integrating the capabilities of technological feedback into a naturalistic, immersive installation we simulate a more immediate dialogue with the natural world with the goal of reestablishing a curiosity of and connection with our surroundings.
Shown at the Artel in Kingston in 2012, at TEI (Tangible, Embedded and Embodied Interactions) Conference in 2012, and Grow-Op (Gladstone Annual Exhibition of Contemporary Art) in 2013.


Occasion Immatriculation Import Infiniti Iris Isere Isere Voiture Occasion Issoire Issoudun Italie Iv.
Location au ski au pied des pistes. Appartement convivial avec coin montagne et balcon,.
At the intersection of the Hautes-Alpes, Isere and the Drome, it is a heady blend of grandiose.
Camping Champ La Chevre enjoys a simply unique and natural setting.


text:
Cubano Chant (Live At The London House, Chicago, 1961)
Disquera: Verve Reissues
I've Never Been In Love Before (Live At The London House, Chicago, 1961)
In The Wee Small Hours Of The Morning (Live At The London House, Chicago, 1961)
Chicago (Live At The London House, Chicago, 1961)
The Night We Called It A Day (Live At The London House, Chicago, 7/29/1961)
Sometimes I'm Happy (Live At The London House, Chicago, 7/29/1961)
Whisper Not (Live At The London House, Chicago, 1961)
Billy Boy (Live At The London House, Chicago, 7/28/1961)
Tricrotism (Live At The London House, Chicago, 1961)
Billy Boy (Live At The London House, Chicago, 1961 / Alternate Take)
On Green Dolphin Street (Live At The London House, Chicago, 1961)
Thag's Dance (Live At The London House, Chicago, 1961)
Ill Wind (Live At The London House, Chicago, 1961)
Kadota's Blues (Live At The London House, Chicago, 1961)
Put On A Happy Face (Live At The London House, Chicago, 1961)
Old Folks (Live At The London House, Chicago, 1961)
Woody 'N' You (Live At The London House, Chicago, 7/28/1961)
Yesterdays (Live At The London House, Chicago, 1961)
Diablo (Live At The London House, Chicago, 1961)
Soon (Live At The London House, Chicago, 7/27/1961)
The Lonesome One (Live At The London House, Chicago, 7/28/1961)
There Is No Greater Love (Live At The London House, Chicago, 1961)
I Remember Clifford (Live At The London House, Chicago, 1961)
Autumn Leaves (Live At The London House, Chicago, 1961)
Blues For Big Scotia (Live At The London House, Chicago, 1961)
Swamp Fire (Live At The London House, Chicago, 1961)
I Love You (Live At The London House, Chicago, 1961)
It Happened In Monterey (Live At The London House, Chicago, 1961)
Billy Boy (Live At The London House, Chicago, 7/27/1961 / Alternate Take)
Introduction (Live At The London House, Chicago, 1961)
On Green Dolphin Street (Live At The London House, Chicago, 7/28/1961)
Moanin' (Live At The London House, Chicago, 1961)
Scrapple From The Apple (Live At The London House, Chicago, 1961)
Jim (Live At The London House, Chicago, 1961)
Band Call (Live At The London House, Chicago, 1961)
The Gravy Waltz (Live At The London House, Chicago, 1961)
Daahoud (Live At The London House, Chicago, 1961)
As Long As There's Music (Live At The London House, Chicago, 1961)
Close Your Eyes (Live At The London House, Chicago, 1961)
Sometimes I'm Happy (Live At The London House, Chicago, 8/2/1961)
Sophisticated Lady (Live At The London House, Chicago, 1961)
Better Luck Next Time (Live At The London House, Chicago, 1961)
Confirmation (Live At The London House, Chicago, 1961)
Los álbumes más recientes de Oscar Peterson
At The Concertgebouw (Live)
Plays Real Pretty
Live in Cologne, 1970
Body and Soul (Remastered)


text:
ACCEPTED

#### According to
The Catalogue of Life, 3rd January 2011

#### Published in
Sydowia 14: 273, 279 (1960)

#### Original name
Manuripia Singer

### Remarks
null

redpajama_set_name: RedPajamaGithub


Hartford-Governor Malloy announced today at the State Armory that Connecticut has ended homelessness among the state's veteran population.
"Today's confirmation of Connecticut's success in ending veteran homelessness is a tremendous and positive step forward in our efforts under the Zero: 2016 Initiative," said Zero: 2016 co-leads Alicia Woodsby, Executive Director of the Partnership for Strong Communities, and Lisa Tepper Bates, Executive Director of the Connecticut Coalition to End Homelessness.
The Zero: 2016 initiative is part of a national effort to end veteran homelessness and chronic homelessness, the long-term homelessness of people living with disabilities, by the end of 2016. Connecticut is one of only four states accepted into the effort through its Reaching Home Campaign, the statewide campaign for preventing and ending homelessness in Connecticut.
The VA Connecticut Healthcare System, the VA's Supportive Services for Veterans Families programs, Department of Housing and Urban Development, the state Departments of Housing and Veterans Affairs, CT Heroes Project, nonprofit providers of homeless services across the state, and the co-leads of Zero: 2016 worked together through the Reaching Home Campaign to meet the goal of ending veteran homelessness. "With Governor Malloy's extraordinary vision and leadership, and through a highly effective team effort, there's been an incredible level of collaboration to identify and house veterans experiencing homelessness," said Woodsby.
Connecticut has housed 766 veterans in the last year to reach this milestone. Through extensive efforts to identify and reach out to veterans experiencing homelessness, and expedite the path for each one to appropriate housing, Connecticut has ensured that veterans are able to move from homeless to housed in under 80 days.
"Every veteran who has moved from homeless to housed is an important victory," Bates said. "At the same time, a critically important part of the achievement is building a system capable of identifying, sheltering, and housing every veteran in need quickly – now and in the future." Federal, state, and nonprofit partners will work together to maintain this system to serve future veterans facing episodes of homelessness.
"This accomplishment is an important milestone that shows what can be done through great teamwork, smart investments, and careful use of resources" said Woodsby.
Now that Connecticut has addressed Veteran homelessness, we are heightening our focus on ending chronic homelessness. National studies show that the chronically homeless population is the highest need segment of those experiencing homelessness, and tend to cycle in an out of expensive public systems like emergency services, hospitals, and jails. National studies show that ending chronic homelessness can save communities 70% of these costs.


THE PRESIDENT: Thank you all. Thanks for coming. (Applause.) I'm honored to be here. I'm honored to be here with the next governor of the state of Mississippi, Haley Barbour. (Applause.) It is great to be in northern Mississippi. I'm proud to be here with a lot of friends.
Finally, I appreciate the fact that Haley Barbour not only has supported me on this issue I'm about to talk about, but is willing to do -- have his own version of a faith-based initiative here in the state of Mississippi. He understands what I know, that some of the problems in our society are problems of the heart; that while government can hand out money, government cannot put hope in a person's heart, or a sense of personal -- (applause.) No, the great strength -- the great strength of America lies in the hearts and souls of our fellow citizens. And you need a governor who is willing to rally the armies of compassion.


The fields to the northwest of the county of Raspberry Haven, protectorate of the hares of the Wide Patrol.
The fearless hares of Captain Burdock Rabscuttle's Wide Patrol received word that neighboring counties were violating the sovereignty of Raspberry Haven. Burdock took a small detachment of his best hares and met with Mellivor Braw, the badger that lived under the oak tree in the northwest corner of the county. Mellivor led them to a hill where he had found strange animal tracks in large numbers, and soon a raiding party of foxes was discovered lurking near a wooded area to the north.
Burdock led his hares out from behind the hill and across the field to take up a position to observe the intruding foxes. Mellivor Braw was not quick enough, and the foxes spotted the Wide Patrol as they entered the woods. Dand-O Flatfoot exchanged a couple of arrow shots with the archers under the fox champion's command, but it quickly became apparent that the enemy was too expert at using cover to hit from afar.
Seeing that they would be shot to pieces if they remained where they were, Burdock declared a charge! The hares bounded across the field engaged the enemy forces in fierce hand to hand combat. The enemy had an assassin in their ranks, who took advantage of Mellivor Braw stumbling and struck the poor fellow when he was down. Bounder was gravely injured, leaving Burdock and Dand-O to fight on alone. The archers of the enemy backed away to attempt a clear shot, but Burdock lept across the distance and engaged them both. Dand-O held his own, fighting bravely.
The enemy's morale was broken, and they were either struck down or fled the field. The hares cared for their wounded, then sang campfire songs while they ate sandwiches and drank buttercup mead.
But the day was not over for the valiant Wide Patrol! As they sang a merry marching song and made their way back toward the hill, a large combat force of mice were spotted coming from the north. Perhaps they had been pursuing the foxes, and were friendly? Burdock didn't like the look of them, nor did he like the menacing sound of their beating war drums.
Burdock led his hares around the east side of the hill, Mellivor Braw the badger following behind. Keeping the hill between themselves and small horde of mice warriors as long as they could, they then dashed across the open field, making for the wooded area to the north.
As they bounded across the field they saw that they had been spotted. A mole combat engineer disappeared into the ground, followed by a detachment of mice warriors. The mice also had an assassin, as well as a leader skillfully directing a group of mice slingers toward the hares. The fearless hares would take cover from their missiles within the trees, and draw them into hand-to-hand combat, an activity the soldiers of the Wide Patrol excel at.
The Wide Patrol formed a skirmish line and braced for a charge from the mice. The mole engineer surfaced near Mellivor Braw, and the badger found himself swamped with angry mice, murder written in their twitching whiskers. Burdock and Bounder charged in, while Dand-O was caught off guard, having to dodge his way through a rain of slung bullets. Dand-O opted to join the brawl instead of trading shots with the mouse slingers. The mouse assassin chased him into the fray.
It was a hard fought battle. Amongst the trees and the broken ground, it was hard for any of the animals to keep their feet. Bounder and Mellivor Braw were both struck down, grievously wounded, though Burdock and Bounder fought on. They were knocked down many times by the swarming mice, yet the two fearless warriors kept up the attack. When Bounder was cruelly slashed while he lay helpless on the ground, Burdock became enraged, charging into the mob of mice and striking a mighty blow.
The shock of the gruesome death caused the mice to break and run. In the ensuing panic and confusion several mice were killed, further deepening the despair of the mouse invaders. When their leader himself abandoned the field the panicked retreat of the mice turned into a complete, brutal route. The courageous hares of the Wide Patrol had proved victorious twice!
Raspberry Haven was safe, the borders secure and the message to the other animals quite clear: this land is ours.


text:
We return in our studies this morning to Luke's gospel, chapter 1. We are looking at verses 67 to the end of the chapter, a section of Scripture known as the Benedictus of Zacharias. Zacharias was a priest who had the privilege of being the father of John, who was the forerunner of Jesus Christ, the Messiah. When John was born, eight days later he was circumcised and Zacharias, in response to the reality of the birth of the forerunner of the Messiah, burst forth in praise starting in verse 67. He is blessing, according to verse 68, the Lord God of Israel because the coming of Messiah means redemption. The Messiah Himself, verse 69, "will be a horn of salvation for us."
As Zacharias offers his praise to God in this passage, he brings before us three great Old Testament covenants: The Davidic, the Abrahamic and the New Covenant. Because of the importance of these covenants, we've slowed down our study of this chapter at this point and we'll need one more Lord's Day to complete it.
Before we look at the text itself, let me pose a question. If we were able to gather all of the various and sundry historians of the world together in one place, and ask them a question, this would be the question I would like to ask: "What was the greatest event in history?" Or, "What is the high point of history?" Or, "What is the most important, influential, and far-reaching, impactful moment in history?"
Now what do you think the historians of the world would say? Would it be a battle? Was that the main fulcrum, the turning point of human history? Was it a war? Was it events that reshaped nations, or reshaped politics, or power in the world? Would it be for some the rise of a great civilization like Babylon or Medo-Persia, or Greece or Rome, or Europe or America? Would it be the fall of some civilizations? Was the turning point of human history the fall of Babylon, the fall of Medo-Persia, the fall of the Roman Empire? Is it the contemporary decline in western civilization?
Or maybe some would say it's the invention of something, like the wheel, or the lever, or electricity, or telegraphy, or the computer.
And some might suggest that it was an idea or a theory, or a philosophy, or philosopher; it was Plato, or Aristotle, or Hegel, or Kant, or Nietzsche. Or some might say it is the invention of democracy or capitalism or free enterprise. Others might suggest that it was a person. Maybe it was a pharaoh or a caesar, or a monarch of some kind or a prime minister, or a president.
But one thing would be for sure. We wouldn't get any consensus. There wouldn't be any one single moment in history, one single, epochal event in history that everyone would agree was the high point. And I'm glad we don't have to get those historians together and ask that question because really it's already been answered. It would be impossible today to get a consensus but there was a time when a consensus was possible and when for all time it was established that everything before this event was B.C. and everything after this event was A.D. History has already answered the question. The most monumental event in all of human history was when God came into the world. It was when Jesus Christ, Son of God, Son of the Most High, was born. History recognizes that one supreme event with B.C., Before Christ, and A.D., Anno Domini, the year of our Lord, meaning after Christ's coming. The great event of world history that rises above everything else like Everest is the event which has been most profoundly influential, most impactful, most shaping of all human history, and that is the coming of the Lord Jesus Christ, God in human flesh, into the world to provide salvation and eternal life for sinners. That is the greatest event in history.
The New Testament gives us the record of that event. And to make it as full and complete as it can be, God the Holy Spirit inspired three men...four men — three to write what we call synoptics and with the addition of John — but the Holy Spirit inspired four men to write gospel accounts: Matthew, Mark, Luke, and John. The story of the coming of God into the world is then understood in its fullness by the composite of those four accounts. The rest of the New Testament epistles and starting with the history of the book of Acts and culminating in the great consummation of the book of Revelation is commentary all on the significance of what is in the four gospels. We're looking then at the greatest event in the history of the world. We're looking at it through the eyes of one of the four writers, namely Luke. And Luke records the coming of God into the world, the birth of the Lord Jesus Christ, in chapters one and two. So we're at the end of chapter 1, about to get into chapter 2 where the actual birth of the Savior takes place.
Now as I said, as we come to our text in verse 67, Zacharias is praising God, praising God because he knows the Messiah is about to be born. The forerunner to the Messiah, his own son John, has just been born about a week earlier. Mary, the mother of the Messiah, the mother of the Savior of the world, the mother of the God-Man Jesus Christ, is already pregnant and he knows that because she has just spent three months living with them. So he knows that the Messiah is about to arrive, the forerunner has been born, the Messiah is only a few months behind. It won't be many years, Zacharias is sure, until the Messiah will launch His great ministry and, as he says in verse 68, redemption will come to Israel. Redemption will come to Israel because a great, powerful Savior, a horn of salvation, is to be born.
Now Zacharias understands the impact of this, as I have been telling you. He understands that this fits in with Old Testament promise. There are three great covenants in the Old Testament that relate to salvation. One was made to David, one was made to Abraham, and one was made to the nation. There is the Davidic Covenant, the Abrahamic Covenant, and what we call the New Covenant because that's exactly what it's called in Jeremiah 31, where it is explicitly laid out. God promised to the nation Israel someday they would have a kingdom and a King would come in David's line. God promised to Abraham and the people who came out of his loins, namely the Jewish people, that someday they would possess the Promised Land and that it would be a time of great and immense blessing and they would serve the Lord in the midst of that blessing so as to be not only blessed but become a blessing to the world.
Well they hadn't yet had the kingdom that God had promised to David. They hadn't yet experienced the greatness of the Davidic promise and sovereignty and a great King out of the loins of David who would not only rule in Israel but rule with a rod of iron and extend that rule over the whole earth. They hadn't experienced that yet. That was to come when Messiah came.
They hadn't experienced the fullness of Abrahamic blessing. They did not possess their land. They were occupied at that time by Romans. They had been occupied by Greeks. They had been under the power of Medo-Persians, under the power of the Babylonians in captivity. They hadn't received their land and the greatness of blessing that God promised them. And they hadn't yet become that great blessing to the world that God had pledged to Abraham; and all of that because they hadn't yet received the forgiveness of sins. How many times had they sinned? How many times did they defy God? How many times had they apostatized or defected from God? How many times had they followed after idols? How many idols had the bowed before? And they had not yet been forgiven for all their sins. There was a generation alive at the time of Zacharias that was apostate, had defected from the true God and was following a path of self-righteousness rather than a path of true repentance and faith and justification.
And so, Zacharias was like the rest, waiting for the redemption of Israel in Jerusalem, waiting for the Messiah to come and come to deliver them from their sins and then to give them the fulfillment of Davidic and Abrahamic promise. And when he realized that the son who was his own son, miraculously conceived, John, was now born, he knew because he was the forerunner of Messiah, the one who would announce Messiah that Messiah wasn't far behind; yes, even now was being formed in the womb of this young girl named Mary. And so he is rejoicing over what is coming to pass. He speaks of David in verse 69. He speaks of Abraham down in verse 73 because he realizes the Davidic promise, Abrahamic promise, is tied to the arrival of Messiah.
Now just briefly look back at the text. As Zacharias was filled with the Holy Spirit and prophesied, we've gone over that in the past, it says that he said, "Blessed be the Lord God of Israel for He has visited us and accomplished redemption for His people and has raised up a horn of salvation for us." In other words, God is going to send the Messiah who is going to save us and bring about the redemption that has been promised.
Then in verse 69 he introduces the Davidic Covenant. The Messiah, the Savior, will come in the house of David, His servant, as he spoke by the mouth of His holy prophets as of old. And he's going back to 2 Samuel chapter 7, back to 1 Chronicles chapter 17, back to Psalm 89 and back to forty other references in the Old Testament to the Davidic Covenant and saying, this is it, folks, the King has come. After all, when Gabriel announced the birth of Messiah to Mary back in verse 32, the angel Gabriel said that He will be not only Son of the Most High, but the Lord God will give Him the throne of His Father David, He will reign over the house of Jacob forever and His kingdom will have no end. So that heightened anticipation.
Surely Mary had informed Zacharias that that's exactly what Gabriel had said, that the Messiah would be not only Son of God, Son of the Most High, but Son of David, the promised King and He would establish His eternal kingdom, a kingdom without end. That's what the angel told Mary. I'm sure that's what she passed on to Zacharias. So he's anticipating this. This is it. Israel, attacked through the centuries, deported, Israel occupied, stripped of sovereignty, stripped of self-rule, under Gentile domination, would someday have its independence, some day have its own kingdom, some day have its own great King and some day that King would not only rule over Israel but over the entire world. The government of the world, Isaiah 9 says, would be upon His shoulders. Zachariah 14 and verse 9 promises the same thing. He would establish the kingdom that is indicated in Revelation 20 to be a kingdom of a thousand years on earth. They were waiting for this. This was great deliverance from their enemies, and that's what verse 71 says, deliverance, or salvation, from our enemies and from the hand of all who hate us.
So the Davidic promise had to do with the political entity of the nation, with the national entity of the nation. That is to say they would be free. They would be sovereign. They would be ruled by Messiah who would deliver them from all oppression, all occupation, all enemies, so much so that the Messiah, from Jerusalem, would reign over the entire world with a rod of iron, exercising great and instantaneous power.
That's what he expected to happen because Messiah was coming. He also expected fulfillment of the Abrahamic Covenant, verse 72. Also he was rejoicing because mercy was coming, mercy which God had showed toward their fathers in the promise that He gave, the holy covenant, the oath which He swore to Abraham. Now remember, that was a promise of a land and a great nation and blessing on that nation like no nation had ever known and through that nation blessing to the world. That was the heart and soul of the Abrahamic Covenant. Not just a kingdom, but all the land originally promised, and blessing, and to be a blessing to the world. That hadn't happened. That would require the Messiah to come. That couldn't happen until they were delivered from their enemy. So he says in verse 73...or verse 72, the Lord has now going to show us "the fulfillment of His holy covenant, the oath which He swore to Abraham, our father, to grant us that we, being delivered from the hand of our enemies," which was part of the Davidic Covenant, "shall now be able to serve Him without fear in holiness and righteousness before Him all our days."
They were going to enter into a time of peace. They were going to enter into a time of prosperity, a time when without fear of attack or assault or evasion or occupation they would serve the Lord. It would be a time of holiness. It would be a time of righteousness, as well as a time of peace. The Abrahamic Covenant was basically given in the book of Genesis to Abraham, Genesis 12 verses 1 to 7 and in that promise that you'll have a great nation, and your nation will be the source of blessing to other nations and you'll have a land that I'll give to you. It was reiterated again in chapter 15, reiterated again in chapter 17 of Genesis, and reiterated again in chapter 22, as we told you. This was the promise of profound and far-reaching and permanent blessing on the nation Israel.
And God, you know, sealed that covenant. We didn't get into it but I'll just refer to it. God did an interesting thing to seal that covenant, to ratify that covenant. In Genesis chapter 15 it says that Abram asked God, "How am I going to know this is going to happen? How can I be sure that this covenant will come to pass?" And God did something to make it clear. God said to him, "Now you go get three animals and cut them in half; a heifer, a goat and a ram. You get them and just cut them in half and lay them opposite each other with a path in the middle and then go get a pigeon and a turtledove and don't cut them in half. They're small enough as...to start with. To cut a bird in half, all you get is a pile of feathers, so don't cut those. Just put the pigeon over here and the turtledove over here so you have corresponding pieces of the three animals and corresponding dead birds lying on the ground and a path in the middle."
It's a strange thing that God is asking Abram to do but he really doesn't argue about it, he doesn't hesitate to do it because it was a somewhat familiar enterprise. Why? Because when in the old time...Old Testament era, during the time of Abram, people made covenants, they had ways to ratify or to legalize those covenants. One of the ways they did it was by blood, blood signifying the seriousness with which this pledge was being taken. An animal would offer its life, there would be death and the shedding of blood to show the seriousness of this pledge, and so they would cut an animal in half and the two people making the covenant would walk between the pieces, therefore signifying the sealing of that covenant in a dramatic way. And that's essentially what Abram is doing. He understands this.
But God does something very interesting in Genesis 15, God anesthetizes him. God puts Abraham out. He puts him into a deep sleep and then when he's in a deep sleep and completely out of the picture, God Himself comes like a smoking oven and like a burning lamp and passes through the pieces Himself. The Abrahamic Covenant was unilateral, the Abrahamic Covenant was irrevocable. It was a pledge that God made to Himself. It was not dependent upon Abram. It was God covenanting with Himself, but He ratified it with bloodshed. Interesting that the Abrahamic Covenant was ratified with bloodshed; so was the New Covenant, namely in the blood of Jesus Christ.
So Zacharias, like all the rest of the Jews, is waiting and he's waiting, as it were, with bated breath for the arrival of Messiah so they can enjoy the fulfillment of the Davidic promise, they can have their own nation, their own King and from that they can rule the entire world. He's anxious for the blessing that God promised to Abraham, that the nation would be blessed, that God would shower them with blessing and that they would then become a blessing to the whole wide world. That's what was in his heart.
He says then, "Having been delivered," verse 74, "from the hand of our enemies, we're going to be able to serve the Lord without fear," that is that there's not going to be any enemy that can overpower us, or overtake us. We're going to be able to serve the Lord without fearing any repercussions because the Lord will rule the whole world. And then he adds, and we're going to do this, in verse 75 "in holiness and righteousness before Him all our days."
You know, short-term obedience was something Israel had rendered in the past. It's true; short-term devotion, short-term worship but never long-term. It went on for a little while and they defected. It would go on for a little while and they defect. They'd have a little bit of a revival and then they'd fall back again.
But there's coming a day when their service to God will be without fear and when it will be in permanent holiness and righteousness. And, folks, that is what the Abrahamic Covenant intended, that they would be blessed because they were righteous. They would be blessed because they were holy. They would be, therefore, a blessing to the world because of that holiness and because of that righteousness. And it would be permanent all our days.
And Zacharias understands this. When the Messiah comes that's what's going to happen, deliverance from our enemies and we're going to be all that God wants us to be, blessed by God and a blessing because of that to the whole world. We'll have our land. We'll have our great nation. We'll have our great blessing. We'll have holiness and righteousness to pass to others across the face of the earth. Messiah would bring that.
But there was another covenant essential to that, and that's the one I want to address briefly this morning. That's the New Covenant. It starts in verse 76. That was just a little review because you need to kind of get the flow here. Verse 76 all of a sudden turns to the New Covenant. It's not named as such, but it's clearly identified, as I'll point out in a moment.
Verse 76, "And you, child, will be called the prophet of the Most High, for you will go on before the Lord to prepare His ways, to give to His people the knowledge of salvation by the forgiveness of their sins because of the tender mercy of our God with which the sunrise from on high shall visit us to shine upon those who sit in darkness and in the shadow of death to guide our feet into the way of peace." Boy, that whole section from verse 76 to verse 79 is so wonderful, the depths of which we're going to plunge next Lord's Day. But for now, just know this. He is talking about the New Covenant. He mentions in verse 77 that salvation which comes from the forgiveness of sins.
Now deliverance or salvation is a big word and it could refer to being delivered from your enemies. It could be...refer to being delivered from occupying forces. It could be used to refer to being delivered from attacking forces. It could be used to refer to any kind of earthly deliverance. And that was involved in the Davidic Kingdom. It could be used to be...to being delivered from depression, from famine conditions, from bad social situations, from all kinds of things. It could be inherent in the Abrahamic Covenant, delivered from anything that steals blessing, being delivered mainly from curses that have come upon you because of your sins. And I think they saw that. Certainly the Davidic Covenant talked about a political deliverance and it talked...and the Abrahamic Covenant talked about a...a kind of social deliverance where life would be filled with blessing, as well as having their own kingdom. But here is the spiritual issue, this is the spiritual blessing that is critical and essential and it's indicated because here is the knowledge of the kind of deliverance that comes, verse 77, by the forgiveness of their sins.
Now we're getting down to the spiritual here. This is not just societal, it's not...it's not the universal rule of the Davidic Kingdom or the national prosperity of the Abrahamic Kingdom. It's the personal work of God in the forgiveness of sin in the individual heart. The New Covenant is a personal one. As I've been saying to you, the Davidic Covenant is global, if you will. It's universal. The Abrahamic Covenant is national. The New Covenant is personal. Zacharias' psalm of praise goes to the personal because he knows they're not going to have the Davidic rule, they're not going to have the Abrahamic blessing unless they come to salvation personally. As I've been saying all along, the only people who are going to enter into the millennial kingdom where the Son of David will rule with a rod of iron on a throne in Jerusalem and rule the whole world, the only people who are going to enter into that kingdom are those who have come through the New Covenant forgiveness, the cleansing that is provided by the death of Jesus Christ on the cross, where He ratified the New Covenant. The only people who are going to enter into the millennial blessing promised to Abraham who are going to dwell in the land and enjoy the blessings and prosperity that God has pledged to be fulfilled in that messianic kingdom are those who are...those coming through the New Covenant. The only people who will be there will be New Covenant believers, those who have been cleansed from their sins, forgiven by the sacrifice of Jesus Christ. Of course Zacharias wants to make this very clear.
Now, as he launches into his discussion of the New Covenant, he begins by looking at the child probably holding in his arms, this little eight-day-old prophet son named John and he says, "You, child, will be called the prophet of the Most High," Most High, El Elyon, God Most High, meaning sovereign God. We discussed that term in verse 32 so we won't go into it again. But it's a...it's a wonderful term referring to God as sovereign. And he's saying to his little boy, and what a proud moment it must have been for that father, "You will be the prophet of God, you will be the prophet of the One who comes as God in human flesh, you will go on before the Lord to prepare His ways." He knows that Mary's baby is going to be the Son of the Most High. He knows that Mary's baby is the Lord. He knows that. And he also knows there hadn't been a prophet for 400 years and here was a prophet, his own flesh and blood, his own little boy. This prophet would be great and he would, as it says back in verse 17, "make a people ready, prepared for the Lord." He was thrilled at the prospect of what his son would do. His son, he probably knew, was the fulfillment of the Old Testament kind of closing promise, Malachi 3:1, "I'm going to send My messenger and he will clear the way before Me." And then chapter 4 verse 5, right at the very end of the Old Testament, "I'm going to send you Elijah the prophet before the great and terrible Day of the Lord." And Zacharias may well have realized that his son is the fulfillment of that promise in Malachi 3:1, he is coming. He is the one coming to be the messenger to announce the arrival of Messiah. He is the one who will be like Elijah. He will come in the spirit and power of Elijah, as Gabriel told Zacharias back in verse 17. So this is an exciting moment as he looks into the face of this little eight-day-old boy.
But his message is to prepare His ways, to prepare His ways. The Lord is coming and you've got to get everything ready for His arrival. "Ways," meaning the paths along which He will come. You are the one to get everything ready for His arrival. John, in John 1:23, John the Baptist, this same child said, "I am a voice of one crying in the wilderness, 'Make straight the way of the Lord,' as Isaiah the prophet said." He was the fulfillment of Isaiah chapter 40, verse 3. He came as the voice in the wilderness, crying out for people to get ready for the Messiah.
And what did he say? Did he say, "Folks, get on your fancy duds, you know, get on your gold and silver, put on your jewelry, put on your fine garments, get ready for a party because the King is coming and we're about to launch into a great kingdom?" Is that what he said? No. Did he say, "Folks, put aside all your future insurance policies, put aside all the funds and all the things you've stored up for the difficulties of the future, shed all your anxiety and all your fear and all your worry because Messiah is coming and with Him will come Abrahamic prosperity, with Him will come the land and all its riches and all the blessing of God will be poured out on us?" Did he say that? No.
When John came preaching, what was the first word out of his mouth? Repent, wasn't it? Repent, because no one would enter into Davidic fulfillment or Abrahamic fulfillment unless their sins were dealt with, and no one would receive the forgiveness of sin who didn't repent and seek it. And he prepared the way for the Lord by bringing people to repentance. That's what he did. He preached repentance. That was his relentless message. Matthew 3, "In those days John the Baptist came preaching in the wilderness of Judea, saying, 'Repent for the Kingdom of heaven is at hand.'" But you're never going to receive it. You're not going to enter into Davidic or Abrahamic blessing without repentance. And then Matthew even adds that he was the one referred to by Isaiah, "The voice of one crying in the wilderness, make way the... 'Make ready the way of the Lord, make his paths straight.'" And he continued to preach repentance and he even questioned the legitimacy of those who repented. You remember, remember he questioned whether the religious leaders' repentance was genuine and said to them, "You better bring forth fruit unto repentance." But that's the kind of preacher he was. He was so convicting that they cut his head off.
You see, the people were looking for a Messiah who would be a national hero, a monarch, a king like David and set up a throne. They were looking for a Messiah who would be literally a provider of a welfare state, who would provide all the blessings that they thought were inherent in the Abrahamic Covenant. That's why when Jesus fed the multitudes and created all the food, they immediately wanted to lift Him up, they wanted to exalt Him as their Messiah and their King because they would see that as the fulfillment of Abrahamic promise, blessing. But before any of that could happen, there had to come the terms of the New Covenant.
You see, they didn't have any understanding about their true situation. They thought that because they were Jews and because the covenant of God to David and to Abraham was irrevocable, unalterable, the gifts and callings of God being without repentance and God being faithful — and they rehearsed that again and again and again that God is faithful to His promise and never breaks it — they assumed that therefore it was just a matter of the Messiah showing up and they would get it all. They knew they needed to be redeemed from paganism. They needed to be redeemed, as it were, from Roman occupation and Roman oppression. They knew they needed to be redeemed from the difficulties of life, the struggles of life, the difficulties that they were incurring in their life, they...they thought that when the Messiah came He would just take care of all of that based on Abrahamic and Davidic promise. What they didn't know was they needed to be redeemed from sin.
And that was the issue and when John came preaching sin, they killed him. And when Jesus came preaching sin, they killed Him, too. And when the apostles picked up the message and kept preaching sin, they killed them because the one thing they would not acknowledge was the...was the true heart condition and the necessity for the application of the New Covenant, which was promised in the Old Covenant and provided in the death of Jesus Christ. So secure they were in the Abrahamic, so secure they were in the Davidic, that when John came and started confronting their dangerous, deadly, self-righteousness, when he brought the conviction of sin and exposed their guilt and their true shame and the judgment of God to fall, they wouldn't hear it. They executed him. But his way of preparing them was to preach repentance. And some heard him and some were ready.
Verse 77 then comes to the New Covenant, this is where we'll stop because our time is gone. Verse 77 says, and when the Messiah comes He's to give to His people the knowledge of salvation that comes by the forgiveness of their sins. This is not theoretical. This is not the kind of salvation that is theoretical or theological or abstract. This is not the kind of deliverance that is political. This is not the kind of deliverance that is societal. This is the kind of deliverance that is connected to the forgiveness of their sins. That's the issue.
You see, that was...that was the bone in the throat of Israel. They choked on that one. They would been happy if Jesus had established the Davidic Kingdom and if He would have unfolded all Abrahamic blessing, wouldn't have been a problem. But when He introduced this issue of the necessity to recognize your sinful condition and repent and be forgiven, it was intolerable to their self-righteous hearts. But this is the New Covenant and the only way that Israel will ever be saved. Romans 11 says, "So all Israel will be saved." The only way that the Jews will ever be saved is when they embrace New Covenant forgiveness. And New Covenant forgiveness requires that they acknowledge Jesus Christ as Savior and Lord because there's only one sacrifice for sin, right? And that's Jesus Christ.
It isn't only a question of understanding that Jesus was born of the line of David and He is a son of David therefore He's an heir to David's throne. It isn't only understanding that Jesus Christ is a son of Abraham, born from the seed of Abraham and therefore is the son of Abrahamic promise. It is also the fact that Jesus Christ though son of David and son of Abraham fitting the qualifications of Messiah, also has to be the Savior of sinners. He has to be the substitute. He has to be the lamb slain for sinners. That's what they couldn't accept. They couldn't accept that they were sinners and they couldn't accept a dead Messiah. Even after the apostles began to preach this, they executed them.
Someday Israel will be saved. Someday God will save Israel. Someday He will remove their blindness. Someday they'll look upon Him whom they've pierced. Someday they'll embrace the New Covenant sacrifice in Jesus Christ and they'll realize that Jesus, son of David, son of Abraham was also the Lamb promised as a sacrifice for sin. And when they recognize that, when they look on Him whom they've pierced, they mourn for Him as an only Son, then, says Zechariah, a fountain of blessing will be opened to Israel. Romans 11 will come to pass, all Israel will be saved and in the future when all Israel is saved, then Jesus returns. Then He returns to establish the promised kingdom with all its Davidic, Abrahamic and New Covenant blessing.
And as I've said all along, you'll be there and I'll be there. Even if we're raptured before the time of tribulation we'll come back down when Jesus returns to set up His kingdom. For those people who are saved during the time of tribulation, they'll go into the kingdom in their normal human form and occupy that kingdom with Christ and with the saints that have been glorified and returned from heaven. But the only people who will go into that kingdom when it is inaugurated are those who have come by way of the New Covenant. And even those of us who are Gentiles, because we all participate in the salvation provided in the death of Christ, we also will enjoy the Davidic Covenant blessing and the Abrahamic Covenant blessing as well.
The specifics of this I'm going to get into next week and you'll find them fascinating. We'll start in Deuteronomy 29 and 30 and march through Jeremiah on into the New Testament where Jesus says, "This cup is the New Covenant in My blood," great, great theme of Scripture. Join me in prayer.
Lord, we have studied this morning like students in a class. We have looked at great theological theme of covenant and finally we have come to that covenant which is most critical, the New covenant. You told Jeremiah that You were going to make a New Covenant with the nation and in that New Covenant would come the forgiveness of sins and a new heart and a new spirit, a great work inside to transform. You reiterated it to Ezekiel and then clearly You fulfilled it in Jesus Christ, who said that His blood, His death was the New Covenant, that You will forgive sin, You will pass by transgression because Jesus bore the punishment for it all. He bore in His body our sins. He was made sin for us though He knew no sin. This is the great New Covenant. It's this we celebrate at the table now, His body and His blood given for us, for Gentile and Jew, the gateway to all the promises made to David and Abraham. Prepare our hearts now as we partake.


If you are a new patient, please arrive at our office 20 minutes prior to your scheduled time. For your convenience you may download all the new patient forms and complete them ahead of time and bring them with you to your first appointment.
To protect you and all the information contained in your record we ask that you provide a picture ID so we may make a copy to keep in your record. For children under the age of 18, who may not have a picture ID, the parents ID will be sufficient.
Always bring your most current Dental Insurance card and/or information with you.
All children under the age of 18 must be accompanied by a parent or legal guardian that can make treatment decisions for the minor child. It is not acceptable to drop your child off or send them with a non legal guardian. Minor children not accompanied by parent or legal guardian will be rescheduled.
We make every effort to arrange a convenient appointment time for you based on your scheduling needs. We also make every effort to respect your time and see you as close as possible to the appointed time. We ask in return that if you are unable to keep your appointment as scheduled that you provide us with 24 hour notice that you need to cancel or reschedule. All appointments not canceled or rescheduled with 24 hour notice will be charged a $35.00 broken appointment fee.
Because being late by 10 minutes interferes with the appointed time of the patient that will follow you all patients that are 10 minutes late, or more for their cleaning appointment will be rescheduled.
As approved providers for the above dental networks we accept as payment the amount of coverage your particular plan will pay.
All deductibles, co-payments, and co-insurance are due on the date of service for all patients for all insurance policies.
For all patients with insurance for whom we are non network providers, we will file your claims as a service to you. Be aware that when using your insurance at an out of network dentist you are responsible for all uncovered services or excess fees that are not covered.
Please make every effort to provide accurate information concerning our insurance coverage as this will prevent delays in payment from the insurance company.
Please understand that insurance reimbursements can be a long and difficult process for our office. In fact, insurers will often stall, deny, and reduce payments. Our insurance and billing staff will make every effort to maximize your insurance reimbursement, while reducing the time by which they pay.
We will accept assignment of insurance benefits starting with your first visit, provided your insurance carrier has a record of paying the provider. If you have a policy that pays directly to the patient only, we will file the claim but you are fully responsible for the bill since the carrier will be paying you directly.
The balance is your responsibility whether your insurance company pays or not. We cannot submit your insurance claim(s) unless you give us your insurance information. Your insurance policy is a contract between you and the insurance company. We are not party to that contract. If the insurance company has not paid its portion of your claims within sixty (60) days, the balance will become your responsibility. Please be aware that some, or perhaps all, of the services provided may be considered non-covered services and not considered reasonable and necessary under your dental insurance plan.
We file with numerous different insurance companies and cannot possible know the benefits or limitation of all policies. As the dental plan beneficiary, please make it your responsibility to know and thoroughly understand what your plan does cover.
Regarding Insurance Plans where we are a participating provider, all co-pays and deductibles are due at the time of treatment.
Additionally, we will file secondary insurance for you if both policies allow for coordination of benefits. In some cases, secondary insurance carriers consider what the primary insurance pays to be compensation enough or have other limitations they use to determine coordination of benefits. Any subsequent payments from secondary insurance will be refunded to you or remain as a credit on your account.
Thank you for choosing Valerie A. Wynne-Hall, D.D.S., Family Dentistry as your dental healthcare provider. We are committed to quality care and service for all your family's dental needs. Please understand that payment of your bill is considered a part of your treatment. Our insurance department and patient finance coordinator will work very hard to ensure your claims are filed accurately and promptly to assist you in receiving the maximum dental benefits that your plan allows.
The following is a statement of our financial policy. Please download from the forms section of the web site the financial policy, which we request you read and sign prior to your treatment. All patients must complete our health history form and, if you wish us to file your insurance, provide proof of insurance coverage prior to seeing a dentist or hygienist.
We will file your services to your insurance carrier; however, your portion of the bill, including the yearly deductible, is due at the time the services are rendered.
We offer CARE CREDIT as an option for third party financing, which can include 0% financing for 12 month for qualified applicants. You can apply by calling 800-365-8295 or visiting their website at www.carecredit.com.
For other policy information regarding missed appointments and insurance, please download the Financial Policy from the Patient Form's page.
Please help us serve you better by keeping scheduled appointment. Unless cancelled, at least 24 hours in advance, our policy is to charge for missed appointments at the rate of $35.00. Three missed appointments may result in dismissal from the practice.
Patient accounts with unpaid balances older than 120 days will be forwarded to a collection agency. Once an account has been forwarded to a collection agency any service provided for any patient on that account is to be paid in full on the date of the service.


Get ready for an ultimately chic addition to your outdoor living collection with the Blok Square Concrete Coffee Table. Part of our fantastic array of Concrete products; the Blok Square Concrete Coffee Table is an essential choice for bringing a touch of industrial, modernism to your seating space.
Please note that our concrete products are handmade with poured concrete, this means that no two will be exactly alike. Each one may vary slightly in size. The table and the base are two separate pieces. Refer to our concrete care page for more information.
W43" x L43" x H12"
The Blok Square Concrete Coffee Table is the ideal size for casual nibbles and drinks! This fabulous piece of furniture can also be used indoors. Imagine your cushy leather suite with this hardy and stunning coffee. Don with some table books or an attractive vase and you'll be absolutely thrilled with the results. Our concrete furniture is easy to care for, simply wipe clean, as you would any table, and enjoy the rustic vibe of incredible concrete in your home.