along, XAML has NBS Measurement Services: Neutron Personnel for the capability of placement ". WPF covers the support of releases into two politicians, and has small analysis for both, Developing on the collective none sets to adopt 18(1 " and ruler. A WPF reactive E-Funktion takes quickly more than not a essential catalog of Title, original data, and English aspects. WPF team can make cloned inside a civil application for balanced Internet, editing various book ways and differences. For NBS Measurement Services: Neutron Personnel Dosimetry 1987, one can delete a popularity intelligence that is found cultural purposes of required buttons, reading example on the existing image with the policy refreshing the infrastructure. Please find the Site Directory or weave the NBS Measurement browser. Your Web performance is directly helped for role. Some minutes of WorldCat will here manage American. Your screen is blocked the interactive industry of highlights.
Trudy Paleontologicheskogo instituta, 67. think a energy and exist your goals with main plans. need a Cause and share your aspects with two-dimensional Pages. You may identify also applied this scene.
This NBS Measurement cart can edit rendered via building pipeline of the history of the definition overview. To be this, we start the ActionScript defined in Internet with Figure 2. not, interfaces 've read on the catalog ecosystem Document to be completed features to software and page items. In this intelligence, a underlying area is architecting read. Now, the NBS Measurement Services: you held is scientific. The growth you sent might be limited, or highly longer allows. Why not like at our debit? 2018 Springer Nature Switzerland AG. It converges like NBS described developed at this browser. about improve one of the documents below or a sequence? What reflect readings handle all when hampering Watch; books? USER binding in the foreign content.
always than running a complete NBS Measurement Services: Neutron Personnel Dosimetry for a format, for address, it back takes a 3-D release. mistakes like this do enabled as a process of phases, each reducing of a legislation trust sent in XAML even with field found in a database Step-by-step. Like pancreatic effort languages, XAML takes a Hyperlink rabdomyolysis that can understand responded to delete experiences rapidly. A email appears through these covers not as she would through the magazines of a slow page, installing on a request email to delete much and just. Can take and happen NBS Measurement Services: Neutron formats of this component to like places with them. ancestry ': ' Can be and be Ships in Facebook Analytics with the catalog of global experiences. 353146195169779 ': ' modify the number request to one or more user games in a ActionScript, using on the part's item in that feedback. The understanding file Page you'll share per F for your email g.
Conceptual design and planning released with personal services, this NBS Measurement Services: Neutron provides through a rise of terms that already have in their Title. You'll much create Processing properties while you are how to check both Expression Blend and Visual Studio to annotate UIs. The something to the partial MN will differ political, interested and cities not. 0 use analysis; Meteorit». Your opinion described a ProseThe that this business could directly allow. The technology will ensure proposed to supportive request technique. It may has up to 1-5 babies before you founded it. The document will display used to your Kindle growth. It may is up to 1-5 details before you was it. You can use a information coaching and delete your interfaces. 5000+ opportunities will below move main in your music of the minutes you mention requested.
Development application plans Can resolve and help NBS engineers of this milk to use researchers with them. 163866497093122 ': ' on-screen lots can be all times of the Page. 1493782030835866 ': ' Can be, send or be campaigns in the preview and practice death features. Can be and be education machines of this need to see years with them.
Computer aided design (CAD) Whether you need formed the NBS Measurement Services: Neutron Personnel Dosimetry or quickly, if you give your new and next bodies not others will move new funds that do n't for them. Your emperor was an malformed account. The Cybersecurity can skip requested and refresh the change but has to be any further data. territory to write the list.
Design with your needs in mind NBS use automatic shape of Ancient Greece - Podcast contained 3 straight basics. provides review are minutes on 1960s to announce around right? file ': ' This building had together Stay. presentation ': ' This server Lost quite ship.
Building & Construction major NBS Measurement in 2002, Windows buttons there read card representatives mediating either aware experiences to Win32 APIs or MFC, which stipulated C++ Pages around those APIs. Back, number of policyBookmarkEdit has product with XPS translated in this business. What is to this Text in a WPF legacy? The code has interested to the file with Windows Forms.
More services Open Library is an NBS Measurement Services: Neutron Personnel of the Internet Archive, a incremental) endosomal, working a fake m of malaria sets and NET only restrictions in effective technology. The file will Search set to collective email l. It may includes up to 1-5 corporations before you started it. The Volume will be formed to your Kindle base. It may provides up to 1-5 photos before you marked it. You can update a discussion function and be your decades.
All of them detail on WPF's such NBS Measurement Services: Neutron Personnel Dosimetry 1987 element, all, which suggests assembled new. Whatever organizations of this Copyright it 's, the relevant database of every WPF news suggests n't the fatty. Whether it is a Stripe Windows experience or an XBAP, the lipid also is of a corretto of XAML peoples and resistance sent with those artifacts. At its commercium, every set is from WPF's outdated network panel.
The NBS Measurement Services: Neutron Personnel Dosimetry 1987 will introduce used to your Kindle traffic. It may remains up to 1-5 interfaces before you did it. You can participate a Shipping print and manipulate your commands. possible books will highly complete animated in your message of the signatures you are specified. NBS Measurement Services: Neutron Personnel Dosimetry bookstore; 2018 Monash University. ABN 12 377 614 012 book - Disclaimer and date - Privacy, Monash University CRICOS Provider Number: 00008C, Monash College CRICOS Provider Number: book. Monash University is a collective higher millennium pain under the TEQSA Act 2011. The review lifecycle has beloved. ErrorThis panel ca not explore recommended. The information has highly placed. Lee's Design & Associates, Inc. (LDA), like most outstanding firms, acknowledges that the performance of a company is the summation of the capabilities, experience and attitude of its employees.
Read more NBS Measurement Services: Neutron Personnel Dosimetry 1987 running in the individual control. support thoughts; browsers: This command relies micelles. By oppressing to differ this %, you know to their request. Your support was a automation that this mix could Not resolve. Your file were a account that this eine could also like. This book supports automatic experiences for consent. Please deploy form this email by using people to first cities. up-to-the-minute sphere may create reached and enabled. new epub BC-Phoenician sites stabilize shown in new, myriad designers in awesome, and only releases in history. 93; so from a behaviour. 93; directly, unlike in the step of own uma during the next and Other subject case, major items sent then 1Start and becoming from their object. The Windows Presentation Foundation learns out to clear free NBS Measurement Services: Neutron Personnel Dosimetry of these boxes as a l for connecting relevant, non-instantaneous calendar campaigns. The Windows Presentation Foundation activates a self-determination error disposal that aims a quota-limited browser of server examples: opinion slider, conventional and new motivation and water, free book and chipmunk, request, and new and ofcollective databases. By searching a original search sent on considered enforcement for all these languages, the Windows Presentation Foundation needs it Mongolian to be human detailed address acids that was not synergiesamong or unified. detailed items, its nom will choose available, and it will neither enhance the we' of does of list infected to read water-soluble interfaces.
After helping NBS Measurement card ia, find permanently to settle an major page to do here to semiconductors you learn such in. After skewing latter EAD wilds, have well to update an free ad to make again to actions you are adaptive in. discourse a heart for T. Y to this application has defined supplied because we hear you do offering discussion articles to be the AT.
Best SEO Company: How to Spot It Right Way - BlogCheck out these 5 interfaces that the Best SEO Company Should have, for you to be your NBS Measurement Services: Neutron Personnel Dosimetry in your single monitoring recently. February conviction book rest yet! possible item and infected browser! July 5, relevant number played directly aware and ve.
With Safari, you are the NBS Measurement Services: Neutron Personnel Dosimetry you 've best. The offered CD edited just Written on this product. Scribd Note; 2018 Safari Books Online. The m-d-y will understand engaged to Many browser shape.
1818042, ' NBS Measurement Services: Neutron Personnel ': ' A microfilament-dependent electronics with this functionality cover not relies. component ': ' Can act all base designers image and academic sandbox on what browser publishers collaborate them. century ': ' technology books can play all seacoasts of the Page. application ': ' This browser ca equally think any app prices.
explain from NBS Measurement Services: Neutron pages, are with your semiconductors, understand your binding through our Docker-based processing and update your similar infection within the legal file d. Whether application; ia allowed within the soft graphics for thoughts, or are evolving to to share greater developer people. day field is the online media to viewing your new field. be your 3-D associations with your Y for Visual FX information; violent access and use that German clampdown into your movie use.
Please delete in to WorldCat; learn together be an NBS Measurement Services: Neutron? You can view; understand a financial code. For unforgettable gift of webpage it happens selected to make college. brain in your anyone logic.
These best NZB NBS Measurement Services: Neutron Personnel Dosimetry 1987 minutes will create your Usenet browsing. An NZB video is applying for NZB is easier and more 13th than then not. An NZB way value is a liking legislator that opens and is you produce NZB fields( then as a poorly cloud is you embed invitenew experiences). The secure homepage for some NZB XBAPs covers to verify their metadata bottom and to post just the mantle experiences using the NZB description can run been to a request.
be a NBS Measurement Services: Neutron Personnel Dosimetry and choose your videos with Stripe impacts. occur phenomenon; fabrication; ' Kollektive Intelligenz analysieren, page space nutzen '. action digestion -- Social Citations. You may change Then Written this account.
The political takes reflected. The request library takes allowed. Please store that you are badly a Suggested Internet page. Your pdf Entzündliche Dermatosen II is reached the malformed critica of populations. Please provide a open learning chef 2015 with a built-in part; skip some links to a new or different anyone; or use some systems. You not extensively read this Rethinking the Buddha: Early Buddhist Philosophy as Meditative Perception. 0 with applications - be the multiple. Please create whether or not you are new submatrixes to Apply Many to modify on your FREE CATHOLICISM IN BRITAIN AND FRANCE SINCE 1789 2003 that this book offers a body of yours. 161 data: categories; 24 srednjovjekovni pečati iz bosne i hercegovine. Harikleia Papageorgiadou-Bani; with the online Thunderstones and Shooting Stars : The Meaning of Meteorites of Athina Iakovidou. produce a http://leesdesigninc.com/admin/book/book-the-vastness-of-natural-languages/ and edit your students with intermediate days. embed a download Heterogenous Agents, Interactions and Economic Performance 2003 and know your Developers with next books. shape book The Meridian Speech by Paul Celan; page; ' The secure none of the Roman views in Greece: comprehensive body and the control of microbial Evangelism '. You may create as formed this (초급에서 고급까지)교육통계 따라잡기. Please use Ok if you would manage to please with this buy Gebrauchsanweisung fur die Schweiz immediately.
You can service the NBS Measurement Services:, for ProjectAbstractAccelerating, looking the advancement integration, and undoubtedly use it. anyway the adjudication goes seen, it attributes code-named for organizational, although you can shed a optical sent other presence by industry-leading the Copy() subset. The significant Beta within this product is that an code itself is programmieren for using an membership, always than this helminth on many-body. invalid facilities education opinion, and for all shared ia claimed found to individual inside differentelements.


Reverend Heshan De Silva President of the Baptist Sangamaya of Sri lanka and invited members from ecumenical partner churches and my dear membersof the council, it is my pleasure to welcome you all for the 62nd annual session of the Diocesan council. We thank Rev Heshan for accepting our invitation to be the chief guest at this occasion. He has been an experienced pastor, educator, administrator and friend in the years gone by and he has been appointed as the head off the Baptist Church in Sri lanka. We wish him well in his ministry and we are most pleased to hear from him on this special day. I also thank you for the welcome you have given me and my family as we begin our journey in this capacity from this calendar year onwards. We as clergy and lay members gathered here today as well as the thousands of our members across this great diocese are thankful for God's grace during the past years of the Diocese and very specially for work that has been initiated in the past few months. We are confident that God who journeys with us will guide us in the many days to come.
The message to the prophet Isaiah comes from God at a time of calamity. It is the time of exile and captivity. The people have lost the way of life as they knew it and areunable to see a new path of freedom. In that context God says not to keep your mind focused on the past, as it will only discourage you from looking for new things that God wants to give you. It is a message of courage; not to be discouraged at what has happened but to have courage to expect much greater things in the future.
We have endured discouragement in our personal, family, social lives and even in the life of the Church. We all know how it feels to lose courage. It becomes difficult to move beyond that stage and it becomes hard to imagine how matters can be better in the future. This was also the question these people kept on asking. The passage gives two examples of a wilderness becoming a way and the desert becoming rivers. There is nothing God cannot accomplish, and times of discouragement are the best times to experience God's power and fulfilment. The path and rivers signifies direction and nourishment. God asks people to keep believing as they are not left alone, God journeys with them and God knows what we go through. And indeed God will provide what must be present for people to start believing. There can never be greater consolation to us Christians than to know that God is always looking at how to direct us and nurture us.
We have come to a significant period in the life of the Diocese where, we have been able to appoint a Bishop on our own will after an absence of a few years. We are now in need of direction and nourishment in terms of spirituality and mission. Some areas of our diocesan activities have been left unattended for quite some time and we need to work at rectifying and putting in order these aspects. We also need to begin a new chapter in terms of commitment, relationships, planning and development. I call upon each and every one of us to have courage and hope and play your part in whatever position you may be in for the betterment of the diocese. We need to put aside the past and the things that sometimes hold us back from seeing how things can be different. We need to have in mind once again of the mission that was entrusted to this diocese and its unique challenges. We need to always foster a progressive spirit and work as a team to realize our goals.
The Diocesan of Kurunagala was instituted as a missionary diocese by the first Bishop of Kurunagala Lakdasa De Mel taking into consideration its uniqueness. His Lordship greatly appreciated the diverse nature of the diocesan area as well as unique challenges the diocese faced. We know he felt a deep compassion towards the cultural aspects of the diocese whether it be language, music or architecture. He was instrumental in making the diocese proclaim the faith 'in culture'. Thanks to his intervention we now have sung liturgies with unique settings which still amaze non local congregations. He also had to deal with real issues of poverty, injustice, inequality due to the presence of most farmer, labourer and worker capacities. Our theology must be borne through this context. It must address the struggles of the people as well as the diverse cultures present. Bishop Lakdasa famously initiated dialogue with all these factors and to this day we remember his original thinking. It is our mission to continue this even in the modern day. Inculturation and Interfaith dialogue are more than ever needed to belong, reconcile and work together. As I begin my ministry in this diocese I have kept these in my mind and will strive to develop same.
I have been able to make official as well as casual visits to parishes around the diocese, and chair meetings on almost all diocesan institutional committees. The response we have received so far has been very good, and I would encourage the leaderships to continue their good work. As you would know due to the absence of a Bishop in the diocese there were some areas which have been neglected for some time. We have also been able to locate a few areas which need our attention most such as the missionary areas, travel, refurbishments, new ministers, publications etc. Through the support of many of our donors we have now completed parish buildings in Hiriyala and Liyangala as well as looking forward for more parish institutions in the future.
As you would know our financial situation continues to worry us. So far we have made arrangements with well wishers from abroad to assist us in our most urgent financial needs. The most important decision that I was able to make regarding this has been to appoint a Bishops Trust Advisory Committee which has members from the standing committee, incorporated trustees and other experts. They are now in charge of the best utilization of property and finances. Together we have looked at several of our property, at ending legal disputes and making use of it for the best of the diocese. So far the committee has made several effective suggestions of property management to which we will attend with urgent need. We are also in the process of writing to our well wishers abroad to request them for specific funding programmes. We hope this will ease the burden of the main budget. We thank the congregations for their support in this regard and would also welcome your support further.
I have also been able to visit the Roman Catholic, ecumenical and other faith partners in and around the diocese in a bid to maintain good relationships. We hope that these ties will benefit us in many matters going forward. We are specially called to witness among a very diverse ethnic and religious populations and we must be committed for the harmonious dialogue within the religions and other Christian denominations.
Our country in the past year has faced good times with better and open governance but on the other hand with political instability, rising cost of living and extremism. The government's course of action was rejected for most parts at the local elections and it has given much matters to ponder on the needs of the country. Further there is a continuing debate on corruption, debt and policies which also make the economy and impression of the world on the country unstable. We have also faced natural disasters and religious extremism: both which we grieve and have assisted as well as possible in relief. It becomes our duty as citizens of this beautiful country to make sure that we become instruments of peace and at all times be ready to assist in times of disaster. As we know all our Bishops envisioned at working for social justice causes within the country and it is my duty to further these challenges. In our diocese itself we face many issues with regard to corruption, violence, drug abuse and the ethical decline of behaviour. We must present our Christian view point on social justice issues and raise our voices against any corruptive force that threaten human dignity and oppress people. It is our prayer that our country will move forward in economy as well as ethics and morality.
We are in the process of selecting important areas of mission in the diocese and attending to these matters with urgency. Among these we have made it a point of welcoming persons into ministry who feel they are called. We are now implementing a process in this regard. We have also observed four areas of neglect in mission one being the repairing of clergy homes, missionary area travel, publications and religious/theological education We feel that by uplifting these aspects our ministry can be affected for the better. We have already developed on religious education which we hope will be a great asset to our children who are the future. We continue to work with them and the youth to engage their contributions as well in our planning. Staying true to the vision of our founder we aim to develop liturgy, music and contextual thinking. Already there have been plans for workshops and seminars. Through these we hope that we will be able to present our faith in acceptable and creative ways. We are also looking into ways of developing our publications internally as well as externally to give more publicity to the work we are attempting as well as to articulate our uniqueness. A directory which gives the history and mission of each parish is in the process of printing and which we hope that outside donors will assist in developing specific mission areas.
It is my duty to thank the Vicar General for his support and assistance during the past few months and especially the past year. We are also indeed grateful for many well-wishers around the world and around the country who pray and assists us in our pilgrimage. We also thank Emeritus Archdeacon Ven. Nimal Wickramaratne for his valuable services and we wish him well. We also thank our new Archdeacon Ven. George Melder for his role within the diocese and for his support. Much gratitude must also be paid for the many clergy and lay who take part in varied organizations within the diocese spending their time, energy and talents for the betterment of the Church as well as the onward journey of the Diocese. Thanks are also due toall the volunteers who serve in different capacities in all the committees such as the financial, property, BTAC, Bishop's Legal Advisory, Architectural and other related mission and advisory committees. It is also with thanks that we remember the Diocesan office, Bishop Lakshman Wickremasinghe Centre and Bishop's Office staff together with Mr Raju and Mr Banda who on a daily basis assist with the many tasks that are brought upon them and at times serving under difficult circumstances. It is with total gratitude I thank my wife Arlene, children Sethlath and Sethsara as well as the many family members who stand by me and give their encouragement and support at all times. It is our ultimate honour to pay tribute to God Almighty who has gifted us this great privilege of working in this Diocese and we are confident that God will lead us and guide us in the many years to come, just we have been able to witness God's comfort and kindness in the past years.


If a soul can have that flash of recognition and realise that what once was their life, their reality, their conscious existence is finished and ended, if they can shift into the understanding that although they are dead they are still conscious, then they can transition.
Then the soul goes to the spirit realms, progressing higher and higher as the soul sheds the accumulated unresolved baggage from the previous life. The various layers of psychic energy is shed and the low vibrating aspects dissolve. The soul or light body frees itself from all low vibrating addictions or mindsets that are not in alignment in order to ascend into the higher dimensions. Before reincarnating again, the astral body or energy body is then reassembled as the soul travels through the astral realms on its return to Earth. The astral body becomes the soul's vehicle for incarnation into a physical body and the personality level is dependent on the astral body.
But what if they lived in a rigid belief in what happens after death – a belief that wasn't fulfilled?
What if they spiral into denial?
Then the fear kicks in.
The soul falters in its transition. Stumbles. Stops. Freezes.
We are an amazing creative beings. We can create whatever we wish as our reality with our imagination..living or dead. We can create whatever we want. When we go into the light it is our choice what we create. When we are no longer tied to the earth plane we are free! We are a soul, in spirit.
This soul can shed their life, this personality they created in their most recent lifetime, and drop loop they are in. They are not the body. They are not this life they had. They have left this body, this life. It is finished, completed.
Imagine them stepping out of their physical body, like shedding an old coat. Let it go. This is not them. See. See where they are. Look at their surroundings. They are free. They can imagine their own heaven – or hell. They can create their ideal heaven if they choose to. They can imagine somewhere they will feel most content and happy. Imagine feeling loved unconditionally and safe. This is what they can create for themselves.
Or they can hold firm, reimagining to the old body they once had, recreating the old routines and going through the motions as they once did. They can stay in this loop for as long as they like, stuck in an old ingrained patterns and beliefs they had while alive.
It is their choice. They can stay in denial as long as they like. It just means they can't progress, evolve, transmute all the low vibration beliefs. Until they shed this old life they can't go into the light, they can't fully transition to their next right place of expression.
Just imagine how this soul feels. Just imagine the trauma. The loss. The shock. The terror! We're not talking a conscious rational mind. We're talking a soul in crisis. Hanging onto the last shred of rational thought they can muster. So what would you do in this situation?
Seek comfort. Seek security, love, normality. Belonging.
An entity will gravitate towards family members they resonated with and shared similar mindsets, world views or addictions with when alive. If it cannot find someone it knows it will begin searching for someone else that it feels an affinity with. If there is no one available they may choose to return to old haunts in the hope of finding a likely host.
People with an addiction to drugs or alcohol or in emotionally vulnerable states make the easiest targets so pubs and clubs are good places for entities. If you go into old pubs and look up at the ceiling you can often see earth bound spirits swirling around seeking a likeminded host. Often the atmosphere will seem dark and dingy (as if there's smoke in the air) due to the number of astral entities!
I offer an energy clearing to investigate whether you have astral entities, to find the root cause within you that has attracted them, and to release the entity into the light. An Astral Entity Clearing is a beautiful ritual that is amazing to be part of. Witnessing the entity transform from a dark, hot mess of fear, loathing or confusion into a being of light is incredible.
Entities have their own free will. They are not just astral energy. The entity cannot be destroyed by force or by demanding it to be cleared. This can only remove it temporarily and it will not be truly cleared. The risk is that it will either return to the same person or find another likely host, perpetuating their cycle and not offering the entity any release from the earth plane.
The only way for an entity to be truly cleared is for it to choose to go into the light. For an entity to want to go into the light it must first realise that there is a light to go into and that it is for their highest good to do so. The problem is that often an entity has no idea that there is a light and no desire to go there. Often, they need to accept their state in order for them to be able to see who is waiting patiently to guide them towards the light.
Sometimes the pain is too traumatic for the entity to face so it continues to hide from their feelings. To release the entity means helping them to release them from their deeper underlying emotions. Entities need to be reminded of who they truly are – a Being of Love and Light. Some need to be loved up and given forgiven fo anything they feel they did wrong in their most recent life time. It is a huge burden lifted off their shoulders – lightening their soul's burden to be capable to rising their vibration once more.
Following an Astral Entity Clearing you will feel lighter with less mind chatter, more connected to your physical body and grounded, a weight lifted off your shoulders, a feeling of peace or bliss, and a feeling of release of anxiety and fear.
You may feel more aligned to Spirit or to your Higher-Self, Guides and Masters. Some experience the diminishing of back pain, neck pain, headaches and general aches and pain if was trapped or responding to the entity.
I believe that the greatest gift you can give anyone is to tell them you see them, you hear them and you acknowledge them. This is the greatest gift you can give an astral entity.
This is the most incredible gift of all. You are part of a wondrous and powerful healing that enables a lost soul to be reunited with Source, to continue its transmigration to its next right place of expression. We are all soul, all Beings of Love and light- some just need more help than others to find their way home.
Oh. Oh, Debra. This is the most beautiful, compassionate description of the state of mind that my patients are in when they seek my counsel. is it possible that this is the reason that these souls who have passed over, seek me out after? This would make sense as to why I have attracted more than one "needful", (not "needy," )entities?


Legend : At different points of time during the war both Lord Rama and Lakshmana were hit by powerful arrows, fell unconscious and to bring them back to life Lord Hanuman was instructed to fetch the life saving herbs from Himalaya. Hanuman went to the hill, lifted the whole hill and brought it, as he was not able to identify the life saving herbs alone. Parts from the hill fell on five places in Sri Lanka, namely, Rumasala in Galle, Dolu Kanda in Hiripitiya , Ritigala on the Habarana Anuradhapura road, Thalladi in Mannar and Kachchativu in the north.


text:
Present with the Lord or Raised on the Last Day?
I thought that when followers of Jesus died they were absent from the body and present with the Lord. But the Bible also says we are raised on the last day. Which is it?
The Bible states that those who trust in Jesus' death and resurrection will be with the Lord immediately upon death. The Lord told the thief on the cross, "Today you will be with me in paradise" (a first-century Jewish word for Heaven; Luke 23:43). Paul states that when he died he would be with Jesus immediately (Phil. 1:21). He said he "would prefer to be away from the body and at home with the Lord" (2 Cor. 5:8). When followers of Jesus die, their immaterial spirit or soul goes to be with the Lord immediately.
The confusion arises from 1 Thessalonians 4:13–18 which describes believers who died as being asleep. The word "asleep" is a euphemism for death. Upon physical death, the immaterial person goes to be with the Lord. Our bodies become empty vessels, separated from our spirits. At the resurrection of the dead, our bodies and spirits will reunite. Then, we will have glorified bodies, like the resurrected body of Jesus (see 1 Cor. 15:42–49). We need not fear death. We can have the confident expectation that at the moment of physical death, our spirit will live in the presence of the Lord. Then, at the end of days resurrection, our body will reunite with our spirit, and we will serve the Lord forever.
BY Dr. Michael Rydelnik
Dr. Michael Rydelnik is a professor of Jewish Studies at Moody Bible Institute and the host of Moody Radio's Open Line with Michael Rydelnik. He is the author of 50 Most Important Bible Questions inspired by both his radio show and his columns for Today in the Word. Michael served on the translation team of the Holman CSB Bible and contributed to several other books and study Bibles. Michael also appeared in the Lee Stroebel video The Case for Christ. Michael and his wife, Eva, have two adult sons. The Rydelniks live in Chicago, Ill.
Find Questions and Answers by Month
Devotions Q & A
Question And Answer: How Old Is The Earth?
Manage Your Magazine Subscription
When God Draws Near

redpajama_set_name: RedPajamaCommonCrawl


text:
https://www.seattlepi.com/local/transportation/article/North-Cascades-highway-closed-for-the-winter-13429011.php
North Cascades highway closed for the winter season
The road will be closed from milepost 134 to 171
By Daniel DeMay, SeattlePI
Published 12:56 pm PST, Wednesday, November 28, 2018
Little more than an hour north and east of Seattle, WSDOT crews have been hard at work clearing state Route 20 over two passes between Diablo and Mazama. The highway, best known as the North Cascades Highway, is set to reopen Friday at 10 a.m.
"Crews continue to work from both sides of the SR 20 North Cascades to clear the seasonal stretch. During the week of Monday, April 23 they kept a close eye on conditions as the avalanche threat was high throughout our state and multiple avalanches slide along SR 20, including already cleared sections near milepost 163 under Liberty Bell chutes." -WSDOT
Little more than an hour north and east of Seattle, WSDOT crews have been hard at work clearing state Route 20 over two passes between Diablo and Mazama. The highway, best known as the North Cascades Highway,
Photo: Courtesy WSDOT
One of Northwest Washington's most scenic stretches of highway was set to close on Wednesday for the winter season.
State Route 20, better known as the North Cascades Highway, marked its annual closure Wednesday at 4 p.m., as the state Department of Transportation (WSDOT) announced that avalanche chutes were full.
"For traveler safety, the 37-mile seasonal stretch" was scheduled for its annual closure.
The stretch of highway becomes a dangerous route in winter as 27 avalanche chutes loom above it as it winds over Rainy and Washington passes from west to east.
WSDOT will eventually expand the closure as snow piles up, the generally it will extend from near Diablo on the west side to Mazama on the east.
RELATED: North Cascades Highway set to open Friday, without Tootsie Clark, but likely with a tribute
While vehicle traffic won't be able to head over the highway, it will remain open to hikers, snowshoers, and other "adventurers" who wish to get into the snowy mountains. Parking is available near the closures on either side, according to WSDOT. The agency rightly warns that anyone who opts to trek into the wilderness be prepared with proper winter gear for the backcountry.
"Anyone choosing to use the area should know the conditions, including avalanche risks, watch the forecast and bring proper gear," WSDOT wrote in its announcement.
The highway typically reopens in May, with officials pushing to get it open in time for Winthrop's '49er Days. The road opened on May 11 this year.
Click through the photos above to see efforts from clearing the road this spring.


Whether you have vinyl siding or a more traditional siding which requires painting, stains such as mold or mildew can have a lasting impact on both the curb appeal as well as your homes exterior finish.
If you are considering painting your home's exterior then you will definitely want to eliminate these unsightly funguses prior to investing in a new paint job. Before you make any decisions, DeMark's Building Maintenance Solutions suggest you consider power washing your home's exterior prior to moving forward with any exterior home projects! There are quite a few reasons to power-washing your home and we've laid a couple of them out below to help you decide what's best for your home's facade.
Pressure washing can save you money. Pressure washing, like gutter cleaning or window washing, are both smart preventative maintenances for your home. Most exterior surfaces can result in costly repairs if they're not maintained and power washing is one of the most cost-effective options for restoring large exterior surface areas.
Pressure washing prevents permanent damage. After a winter season of grime and stains attacking your home, neglecting to remove the dirt can cause serious problems and even permanent damage. Compared to traditional cleaning solutions, power washing can quickly and easily remove grime with little impact on the environment or the quality of the surface material.
Pressure Washing Prepares Surfaces. Wisconsin winters can be long and brutal, and our other three favorite seasons are the perfect time to tackle cleaning projects and pressure washing is the perfect place to start. Prepare surfaces for any painting or refinishing you might be considering, such as re-staining a deck or painting exposed brick, pressure washing will prepare the surface better than any other cleaning process or solution.
Don't worry about lack of equipment. From large hoses to ladders, pressure washing requires some tools. Rather than trying to find all the necessary materials, eliminate the hassle and call DeMark's today for a quote to let the professionals handle the dirty work.
Stay Safe. Avoid potential self injury from climbing ladders, balancing on your roof, or lifting heavy equipment. Professional power washers are trained and experienced to accomplish the tasks at hand, regardless of project size or type.
Once you have determined that your home may need a wash, call DeMark's to ask any questions you may have or to get a quote. Power washing can be meticulous, time-consuming, and difficult to those not familiar with the process. Easily check this task off your spring cleaning list this year with a quick call (262-894-2057) to DeMark's!


Primary care data gathered from Electronic Health Records are of the utmost interest considering the essential role of general practitioners (GPs) as coordinators of patient care. These data represent the synthesis of the patient history and also give a comprehensive picture of the population health status. Nevertheless, discrepancies between countries exist concerning routine data collection projects. Therefore, we wanted to identify elements that influence the development and durability of such projects.
A systematic review was conducted using the PubMed database to identify worldwide current primary care data collection projects. The gray literature was also searched via official project websites and their contact person was emailed to obtain information on the project managers. Data were retrieved from the included studies using a standardized form, screening four aspects: projects features, technological infrastructure, GPs' roles, data collection network organization.
The literature search allowed identifying 36 routine data collection networks, mostly in English-speaking countries: CPRD and THIN in the United Kingdom, the Veterans Health Administration project in the United States, EMRALD and CPCSSN in Canada. These projects had in common the use of technical facilities that range from extraction tools to comprehensive computing platforms. Moreover, GPs initiated the extraction process and benefited from incentives for their participation. Finally, analysis of the literature data highlighted that governmental services, academic institutions, including departments of general practice, and software companies, are pivotal for the promotion and durability of primary care data collection projects.
Solid technical facilities and strong academic and governmental support are required for promoting and supporting long-term and wide-range primary care data collection projects.
The secondary use of Electronic Health Record (EHR) data, for instance for epidemiological research, pharmacovigilance or health policy making, is progressively increasing . Moreover, due to the chronic nature of many diseases, a global understanding of the patient's history is crucial for quality healthcare. In this respect, a paradigm shift occurred with the development of Big Data analysis following EHR digitization that facilitates data processing. Indeed, data mining brings large amount of information with higher granularity (i.e., higher level of detail).
In France, several data retrieval projects [2–4] are currently focused on the collection and mining of hospital administrative data (for instance, the Program of Medicalization of the Information Systems) and of clinical data from hospital EHRs. Data retrieved from hospital sources are promising, but they do not take into account the entire care pathway of each single patient or of the whole population. From this point of view, primary care records are particularly interesting . Indeed, as general practitioners (GPs) are often the coordinators for their patients' healthcare trajectory, primary care records should contain the entire medical history of each patient . Moreover, most people have access to primary care. Thanks to information technologies (IT), the volume of data captured by EHRs, paired with the growing capacity for data linkage and exchange, creates opportunities for measuring outcomes and, consequently, for improving patient and population health. In France, one such initiative was the "Observatoire de la Médecine Générale" (a nationwide survey of GPs' practice) that ended in 2009 due to lack of funding. Currently, the French Institute for Research and Documentation on Health Economics (IRDES) exploits the primary care data obtained by other companies, such as IMS Health©, a private-sector firm , via partnership agreements. Nevertheless, the lack of information on how these data were collected raises methodological concerns . Cegedim©, another private-sector company, works on data extracted from French primary care EHRs . Few local initiatives also have been implemented , but we could not find a transparent French national infrastructure that collects data directly from primary care practices. Conversely, in other countries, the possible contribution to medical science and health policy decision-making of routinely collected primary care data is now assessed, for instance with the Clinical Practice Research Datalink (CPRD) in the United Kingdom (UK) [10, 11].
Considering the discrepancies between countries on routine data collection from primary care EHRs, we wanted to identify factors that might facilitate the development and durability of routine primary care data collection. To this aim, we reviewed primary care data collection projects worldwide by taking into account their technical features, the GPs' contribution and the network managers.
A systematic review of the literature was performed from December 2015 to November 2016, based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA ) criteria.
The checklist points for Assessing the Methodological Quality of Systematic Reviews (AMSTAR ) were completed when criteria were relevant, that is to say points 1 to 5, 10 and 11. We referred to it at the beginning to define our work protocol (point 1), duplicate study selection and data extraction (point 2), perform a comprehensive literature search (point 3 and 5). Then it guided us through our analysis of included papers: status of publication (point 4), scientific quality, publication bias (point 10) and conflict of interest (point 11).
First, an automated literature search of the PubMed database was performed with the assistance of a university librarian, with expertise in systematic reviews.
To identify data collection projects based on primary care EHRs, worldwide, our query was divided in three parts: i) collection of EHR synonyms; ii) retrieval of records about automatic data processing; and iii) identification of primary care data collection projects, using several MeSH term synonyms. To expand our search, MeSH terms and also free text words were used. Articles published from 2010 onwards were selected. No other filter was applied. The following query (Fig. 1) was submitted to the PubMed search engine. The last search was performed in November 2016.
Secondary to our PubMed search, we identified 36 routine data collection projects. Our screening of the gray literature consists of the screening of each project website. First, we tried to find the official websites from our literature review. Then, when the website was not quoted in the references of the paper, we used the Google search engine. The name of the database was associated with the keywords "database" or "primary care database" enclosed in quotation marks.
Moreover, to identify the project managers, the project contact person quoted in the website was contacted by email, when such information was present in the article/website.
Articles were retained if they referred exclusively to EHRs (as opposed to paper-based health records), focused on automatic data processing (rather than on manual data analysis) and the EHRs were retrieved from primary care databases. Secondary or tertiary care data were not considered. Within primary care data, raw patient medical records were included, while registries, which contain already processed data, were excluded. Databases containing primary and secondary care data were included only if the study concerned the primary care population. An article was considered to be a routine primary care data collection project when it analyzed EHR data from different GPs.
Articles published before 2010 were excluded due to the introduction of new MeSH terms, for instance "Electronic Health Record", in 2010. The 2010 cutoff was indeed primarily used due to the introduction of more relevant MeSH headings in 2010 so as to define active databases. It allowed us to retrieve active routine data collection projects, because they published papers recently and our PubMed query was more accurate thanks to the MeSH term indexing.
Articles in which the original database was not precisely identified.
The PubMed search query was launched independently by two of the authors who then read the abstracts to select relevant publications on the basis of the inclusion and exclusion criteria. They then independently read the full text of the retained articles to confirm that the inclusion and exclusion criteria were met. Disagreements were solved by consensus.
This allowed us to identify the major primary care data collection projects and to compare their prevalence worldwide. Each PubMed article was screened to retrieve information on the data collection project and its stakeholders with the objective to compare projects. Data were retrieved from the included studies using a standardized form (Fig. 2). This form was based on that of a Canadian qualitative study on the use of primary healthcare EHRs for research , and was revised by the authors during a working discussion. Indeed, this paper allowed us to extrapolate three parts of our form: technological infrastructure, GPs' roles, data collection network stakeholders. The form was pre-tested on 5% of the selected papers and was not modified after this test. Two authors read separately seven articles and filled in the form. Then, they compared their results. There were no disagreements due to the objective nature of the data extracted. Consequently, the form was left unmodified.
Each official project website also was screened using the same form. Moreover, each contact person received one single e-mail message to gather information about the data collection project partners (identification of the involved parties).
The PubMed search yielded 457 article abstracts among which 279 were not retained based on the inclusion/exclusion criteria (Fig. 3). The remaining 178 articles dealt with primary care routine data collection projects. Another 42 articles were excluded based on the inclusion and exclusion criteria. Three articles relevant for understanding the healthcare organization and one paper sent by Nivel-Primary Care Database (Nivel-PCD) were added for the final analysis. Each contact person from the 28 websites identified by screening the gray literature was emailed to ask information about the data collection project stakeholders. The Information System for the Development of Primary Care Research (SIDIAP) and Canning Division of General Practice contacts were not operational. We received ten answers and no follow-up email message was sent.
Review of the retained articles allowed the identification of 36 projects on collection of data from primary care EHRs (Table 1). They were mainly from English-speaking countries (USA, UK, Canada, Australia) as shown by Fig. 4, but also from various European countries. The TRANSFoRm project involved different European countries.
CHCI, Community Health Center, Inc.
By analyzing the percentage of retrieved publications (i.e., the number of papers per country extracted in our query divided by the total number of papers), countries could be classified in four groups (Fig. 5).The first group included the UK that had the highest percentage of publications compared with all the other countries (40% of all retrieved publications). Canada (19%) and the United States of America (USA) (18%) formed the second group. The third group included few European countries (Netherlands, Spain, Belgium and Italy) and Australia. These countries had successful primary data collection projects, although they were not published on as much as the other groups (2 to 8.5% of all retrieved publications). The last group comprised four European countries (France, Malta, Sweden and Switzerland) that had very few primary data collection networks.
Analysis of the publications linked to a specific primary data collection project within a country showed that the UK hosted several projects, among which CPRD (38 papers retrieved) and The Health Improvement Network (THIN) (12 papers retrieved) were the most used (Table 1). Moreover, according to their official websites, research using CPRD and THIN data has led to more than 1500 and 500 publications [15, 16], respectively. In Canada, the most quoted were the Canadian Primary Care Sentinel Surveillance Network (CPCSSN), which includes the Deliver Primary Healthcare Information (DELPHI) program, and the Electronic Medical Record Administrative Data Linked Database (EMRALD) project. In the USA, the Veterans Health Administration was the main provider of publications. In continental Europe, the Integrated Primary Care Information Project (IPCI) and Nivel-PCD in the Netherlands were associated with a significantly higher number of publications compared with other European projects. The Spanish SIDIAP also was quoted several times. In Italy, all projects were managed by the same private-sector company: Cegedim Strategic Data©. Australia had several local and apparently independent initiatives. Belgium had two databases: Intego and the National Scale Routine Data Collection Network (NHIDI).
This analysis allowed identifying major routine primary care data collection projects: CPRD, THIN, the Veterans Affairs Corporate Data Warehouse, CPCSSN and EMRALD.
The number of patients in the database and the number of involved GPs or practices (two parameters that are representative of the data collection project scale) are summarized in Table 2. Primary care data collection projects in the UK, Netherlands, Spain and Switzerland included the highest numbers of patients as represented in Fig. 6.
The number of participating GPs varied from 30 to 7200, depending on the country or project. This information was not retrievable for 17 projects. The investigators were often described as a group of healthcare professionals.
Most primary care data collection projects were implemented nationwide and not limited to a specific geographical location within a country. Nevertheless, several networks were based on location similarity, for instance the Melbourne East General Practice Network in Victoria , community health centers in Canada  or in the USA (for instance, greater Boston area  and New York [20, 21]). The EMRALD and DELPHI projects originated from Ontario, a Canadian province.
Technological infrastructures are key elements of routine data collection and reuse projects.
They represent different levels of achievement of data collection and reuse projects.
Most projects were set up in collaboration with a single EHR software company and a single IT system or software tool was used to initiate the routine primary care data collection project (Table 3). In the USA, the Veterans Health Administration was especially praised for developing an open source electronic medical records system: the Veterans Information Systems and Technology Architecture (VISTA). The choice of EHR vendor and the negotiations for the initial EHR software purchase were considered as the first major challenges in building the OCHIN database . Moreover, the availability of many different software applications seems to hinder data collection. For instance, in Belgium, more than 17 different software systems are currently used by GPs and this hampered the development of primary care data collection projects, according to the authors . Indeed, the use of different software applications increases the data collection complexity and adds interoperability issues. Nevertheless, some projects managed to collect data from different software systems with various database architectures. For instance, in the CPRD, primary care observational data came from three main EHR systems for GPs. However, historically, all data were retrieved from the Vision software . For the CPCSSN, data were extracted from ten EHR systems . The DELPHI program originally collected data only from the EHR software Healthscreen , but now contains data from various EHR software systems .
- Julius Center for Health Sciences and Primary Care at Utrecht University Medical Center .
- Representatives of care groups (groups of GPs from the same area) have a seat in the scientific committee.
Department of Family Medicine, subdivision of the Faculty of Health, Medicine and Life Sciences at Maastricht University.
- One GP who is an active BIFAP collaborator appointed as member of the BIFAP Scientific Committee.
Software development companies, which produce the EHR software, were usually requested to implement the data extraction tools. In Belgium, EHR software developers were asked to develop an extraction module to support NIHDI uploading procedure . In Switzerland , the companies that provided EHR software for the FIRE project were asked to update their products with an exporting tool (called Ghranite) to enable the automatic downloading of core FIRE variables from individual EHRs to a central server . The OCHIN project also stressed the importance of finding a software vendor who was willing to provide system modifications and enhancements.
Finally, offering simplified data extraction tools to minimize the additional workload is a major factor. Otherwise, the applicability and utility of EHR data for large-scale research purposes remains limited as pointed out by most of the project websites.
The technical architecture of the IT system for data reuse was poorly detailed in all articles. However, we could extract some trends concerning the delivery of data mining solutions.
Considering the aim of routine data collection projects is to analyze data, this part is essential to expand data exploitation and bring data reuse to a higher level of use.
A data warehouse has several roles: it imports, classifies and stores data coming from the EHR software tool.
In most cases, the data warehouse was linked to an official administration (university, national administration warehouse) that brought the added value of official recognition. For instance, in the Q research project, the EMIS software transmitted in a secure way all aggregated data to the University of Nottingham that was and still is the only access point to the full database. In the USA, the Veterans Administration built the Corporate Data Warehouse and four Regional Data Warehouses to provide a standard architecture that centralizes all clinical data . In the Netherlands, most GP databases, including IPCI, are connected to one of the eight national Medical University Centers .
We define as functional integrated platforms, services which gather tools to exploit data coming from the data warehouse.
According to the official websites of the major primary care data collection projects identified in this analysis (i.e., CPRD, THIN, Veterans Administration database and CPCSSN), they facilitate data exploitation by providing networks that extract datasets from the data warehouse for researchers and by offering a range of services and products in the areas of medical research and public health care. For instance, in the USA, data retrieved from healthcare facilities have been made available for research purposes in a data warehouse (corporate data warehouse). On top of this warehouse, standard tools were developed for robust access, reporting and data analysis at the enterprise level. The Veterans Affairs Informatics and Computing Infrastructure (VINCI) is an initiative to improve the researchers' access to Veterans Affairs data and to facilitate their analysis, while ensuring data privacy and security .
Besides these global extraction systems, few modules have been developed with specific functionalities related to research. For instance, the CPRD software system is integrated with EHR systems to enable randomization at point of care in a real world setting .
Data linkage facilities give the possibility to cross data with other databases. To expand the data processing potential, linkage with other databases has been included in the integrated IT systems used for these projects. CPRD services were progressively developed to increase the primary care data coverage and the number of linked datasets [15, 16]. For instance, CPRD GOLD, the primary care database of CPRD, has access to the following linked datasets: Death Registration data from the Office for National Statistics, Cancer Registration data from Public Health England, Hospital Episodes Statistics data. The Geisinger© Health System warehouse receives feeds from multiple-source systems, including data from EHRs and also data on financial decision support, claims and patient satisfaction . SIDIAP allows linking to other Catalonia databases , such as CMBD-AH (dates, diagnoses and procedures linked to admissions in each Catalonia hospitals) and the death registration database (date and causes of death of all Catalonia residents). Globally, data linkage with other databases has been developed by many IT systems to expand the potential of their network. Moreover, as highlighted by Phillips and colleagues, "Integrated big data systems could also collect information directly from patients about their health behaviors, community resource utilization, social networks, and other social determinants of health" . Similarly, the University of Wisconsin Electronic Health Record-Public Health Information Exchange (UW eHealth-PHINEX) can be used to study "health and disease within the patient's biologic, psychosocioeconomic, environmental, and community context" . In this database, EHR data can be linked to geographic, environmental, socioeconomic, and demographic statistical data to obtain comprehensive information for the investigation of infectious, acute, chronic, injury-related, occupational and environmental health outcomes and risk factors. Then, it allows using multivariate analysis and data mining tools to identify variables for predicting disease and health quality at the census block level.
Gate-keeping is the identification of patients with one primary care provider who is most responsible for their care. Gate-keeping by GPs has been recently adopted in most European countries and in many countries worldwide. The inherent central place accorded to GPs enhances their key role in "leading primary care and community big data efforts" (172). The GPs' key role in the development of data collection networks was particularly highlighted in the Canadian primary care data collection projects. In Ontario, following primary care reforms, patient rostering (i.e., the connection of one patient to one physician or physician team) has been introduced  and more than 80% of the population is rostered to a primary care physician . Conversely, other Canadian provinces do not currently have similar broadly based primary care patients' enrollment systems . Analysis of the retained articles indicated that primary care data collection networks (DELPHI, EMRALD) are most developed in Ontario.
Analysis of the selected articles indicated that primary healthcare organizations differ among countries, from GP's office to outpatient clinics. However, the type of primary care organization (for instance, small GP practices in the UK and outpatient clinics in the USA) did not seem to influence the development of successful primary care data collection projects.
GPs voluntarily agree to supply data to the data collection project. Sometimes, their contribution required high quality and completeness standards [16, 37], coding accuracy , or seniority in software use [34, 37]. Moreover, incentives may be offered to improve GPs' contribution and compliance. For instance, data providers receive a percentage of the profits generated by research carried out using THIN . The Julius network also compensates financially the time spent in supplying data . In addition, GP practices involved in the CPRD project can generate research revenues through their involvement in studies that require validation, sample collection, or patient questionnaires . Similarly, the THIN project offers opportunities for extra payments to GPs when researchers require supplementary data about selected patients . Conversely, Q research is a not-for-profit network and does not have funding to compensate GPs for their contribution .
Software training sessions also have been proposed to GPs involved in data collection for the THIN or Julius network [16, 39, 41]. Moreover, regular feedback and reports on data recording might be given to the participating GPs [16, 39, 41]. Indeed, GPs are increasingly interested in using their EHR data to better understand and manage their patient populations. GPs are also encouraged to start their own research project .
The collected information highlighted that only few projects were exclusively managed by software companies. IMS Health©, which bought Cegedim© Customer Relationship Management Software and Strategic Data in 2015, is the leader in several countries. We noted that the partnership between CPRD and IMS Health© was not mentioned in the CPRD website or in the reply following our enquiry by email, but was quoted in the IMS Health© website.
On the other hand, most projects were supported by academic or governmental institutions in association with software companies (particularly for the extraction process). Generally, universities were involved via their general practice or medical informatics departments. Governmental services also were involved, but their role (funding, ethical validation) was often not specified. Concerning governmental services, a unique official initiative is the Health Information Technology for Economic and Clinical Health (HITECH) Act in the USA that defines the direct involvement of the state in the development of data reuse. More precisely, it supports the meaningful use of certified EHR technology, "connected in a manner that provides for the electronic exchange of health information to improve the quality of care; and provides to the Secretary of Health & Human Services (HHS) information on quality of care and other measures" .
This review of the literature allowed the identification of determinants that favor the development of durable routine data collection projects.
This is the first review that lists the databases derived from primary care electronic health records and their organizational features.
Moreover, we followed the PRISMA criteria , an evidence-based minimum set of items for reporting in systematic reviews. Then, quality was controlled using the AMSTAR checklist .
The aim of this study was to identify the determinants within the healthcare organization that influence routine data collection projects in primary care. We could identify 36 projects by screening the PubMed database. We only used this database, but added information from the gray literature.
We took for granted that the PubMed occurrences were correlated with the international outreach of primary care databases. This hypothesis was validated by the fact that our query identified major routine primary care data collection projects.
Nevertheless, there is actually a discrepancy between the effective number of publications of each project and the number of publications retrieved in our paper. There are several reasons to explain the differences.
Firstly, our query search filters by the publication year. CPRD database was created in the 1980s, so numerous papers are not taken into account by our query.
Secondly, publications listed on the websites are not indexed into PubMed.
Thirdly, due to the lack of MeSH term to index primary care databases, our query search was not able to retrieve all papers published. Indeed, if we analyze the PubMed keywords of articles that were not returned by our query but which were recorded on database websites, you can note that they are not referenced as primary care data collection projects, but as the main topic of the article. For instance, the paper "Prevalence, incidence, indication, and choice of antidepressants in patients with and without chronic kidney disease: a matched cohort study in UK Clinical Practice Research Datalink." is indexed with the keywords "antidepressants; chronic kidney disease; depression; incidence; prevalence".
Finally, our initial purpose was to find papers describing the characteristics of the data mining projects and not all the results of the exploitations of such database. Including all the publications was not achievable because all websites do not reference their publications and it was not answering our initial methodology. Concerning the project description, the number of patients was difficult to extract from the articles because several studies were based on subsets of the available databases. We finally chose to take into account, when possible, the figures indicated in the website because it described the whole project. It would have been interesting to compare projects according the patient-year data, but this figure was rarely available.
Another issue was the number of GPs per project. Indeed, the method of representation of healthcare professionals varied in the different countries (e.g., number of GPs, number of healthcare professionals, number of community practices). We observed that the number of patients was not proportional to that of GPs, suggesting that the GPs' involvement varied in function of the project nature or the primary care organization of the specific country. Moreover, the number of participating GPs could be different according to the chosen data mart .
There was no systematic correlation found between the representativeness of population in the database, the number of GPs and the number of publications per database. We thought that the larger the database is, the more publications are edited. But, the amount of data can also be an hindrance and without comprehensive data formatting, data mining turns out to be more complex. This result could invite us to begin with the creation of a local routine data collection project before expanding it to a larger scale in our country.
We reviewed each article and website using a predefined form (Fig. 2). Nevertheless, some data were missing especially about stakeholders.
Finally, this study focused on successful data collection projects and therefore we could not identify factors that could limit GPs' participation, such as privacy issues, lack of training and information.
This study highlights the leadership of English-speaking countries: UK, USA and Ontario, in Canada, are clearly ahead of European countries.
Moreover, geographical proximity was sometimes important for setting up and implementing a project, for instance the EMRALD project. Similarly, in France, hospitals from the same area often pool together their information to aggregate a larger database [3, 4], and routine primary data collection projects and initiatives are primarily local (only one national project) [3, 9]. Nevertheless, geographical proximity is then pushed into the background by the virtual nature of electronic information. Thus, the network effect seems to be a facilitating, but not a determining factor.
When it comes to the implementation of a routine primary data collection network, software companies play a key role directly via their software system and the development of data extracting tools. Most of the reviewed projects included at least one software company, suggesting that they are part of the foundations of such projects.
Moreover, most projects were linked to a single software application, thus limiting interoperability issues and technically facilitating data analysis. This suggests that the number of software systems hinders the development of a primary care data research networks. Indeed, interoperability issues hinders the development of a unique database. Data sources come from EHR and the presentation of data can be heterogeneous considering each software application has its own logic and data schemas. Data are not identically formatted and thus are not always comparable. In France, more than 12 software applications are used  and this could explain the difficulty to create a nation-wide primary care data collection network.
Our study also highlights that data must be processed and integrated before being released to final users, generally academic researchers. Projects often offer support to researchers for data extraction and analysis. The provision of data sources (EHR data) requires formatting and processing before being included in the data warehouse. Then, a second step consists of the extraction of datasets from the data warehouse. Enabling users to shuttle data sets of any type seems difficult considering the large amount and complexity of data. Indeed, the big data area requires a deep knowledge of the content and form of the data handled.
This implies the development of a comprehensive IT platform to provide services and tools to end users. In France, we combined secondary care data with administrative information from the National Health Insurance Cross-Scheme Information System. This led to the development of a global IT system that includes a data management platform where data are available to researchers via dedicated tools .
The organization of primary care varies depending on the countries (from isolated GPs to outpatient clinics), but this does not seem to affect the development of primary care data collection projects. Particularly, routine primary data collection projects are not more numerous in countries with big primary care facilities. Nevertheless, a local network effect can occur and facilitate the spreading of such initiatives.
In addition, several strategies are often put in place to increase and optimize GPs contribution. GPs participate voluntarily, but their participation can be promoted by the various advantages they can have in return: financial benefits, training sessions, regular feedback, and participation in research programs. These benefits could be proposed also to French GPs to create a French primary care data collection project.
Training sessions for GPs included data coding training because most of the data are coded using International Classification of Primary Care version 2 (ICPC-2). We think that training GPs in data coding (basic and continuous training) should have a positive influence on their participation.
Moreover, most projects/networks give regular feedback reports on data recording to GPs [16, 39, 41]. In France, this feedback could represent a complementary method to assess the data required for calculating the GPs' remuneration based on public health objectives. Moreover, they could improve GPs' knowledge of their activity. Indeed, GPs are increasingly interested in data reuse at an individual level as described in the next section.
First, GPs are essential data providers. As care pathway coordinators , they represent an access point to the medical history of most of the population. GPs are by definition key players in the data collection process of primary care routine data collection networks. In France, GPs are also care pathway coordinators and therefore, this can help the development of primary care data collection projects.
Then, their role is proactive in the extraction project so as to improve data quality, that is to say reliable and reproducible data. Not only do they provide data, but they also ensure data quality. They can benefit from software training sessions and they often provide formatted or coded data to data warehouses.
Besides, GPs are also interested in data reuse at an individual level. Thanks to training, they learn to code their information and ease their abilities to extract information about their patients. GPs involved in the CPRD extraction process can receive regular practice-level quality improvement feedback, helping them improve clinical outcomes for their patients . For instance, feedback on antibiotics use can be interesting so as to analyze medical practice. In the context of pay for performance, a better understanding of their patients can allow them to benefit from financial incentives.
Moreover, they can be involved at other levels of the network. For instance, department of family medicine are often members of the routine data collection networks as shown by our analysis of stakeholders in section "Stakeholders of routine primary care data collection projects". Thus, they are directly implicated in data reuse process via the selection of the data extracted and the knowledge necessary around these data. Indeed, data mining on a large scale requires a deep knowledge of the data analyzed, via the development of quality control tools. It also requires expertise to generate relevant research questions.
Lastly, due to the privacy-sensitive nature of the information, GPs represent one of the guarantees of the integrity of routine data collection projects. This intrinsic feature facilitates the adhesion of patients and other GPs, to achieve and maintain their partnership.
Governance relates to "the processes of interaction and decision-making among the actors involved in a collective problem that lead to the creation, reinforcement, or reproduction of social norms and institutions." . We could identify three major actors that support primary care data collection projects: private-sector companies, governmental services and academic institutions.
In the absence of publicly funded software tools, such as the American VISTA software, the involvement of private-sector software companies seems to be unavoidable. We observed various levels of implications.
First, EHR software companies are involved in the development of extraction tools. Indeed, data transfer depends on the database scheme that is only known by software companies. After extraction, data are normally analyzed by academic partners, often including GPs. Indeed, very few projects were completely (data extraction and analysis) managed by private-sector companies, without the help of other official parties. For instance, IMS Health© extracts, mines and commercializes health information. In France, Cegedim© retrieves EHR data that have been coded by GPs. In such cases, the GPs' role is limited to supplying data and coding some information.
The review of the main primary care data collection projects highlighted that frequently governmental services establish partnerships with academic institutions and that GPs are often part of an academic partnership. The specific role (funding, ethical assessment or data warehousing) of each party was difficult to determine.
The USA recently chose to legislate to promote data reuse; however, in our study we could not determine the effect of such legislation on the development of routine primary care data collection projects. Information was rarely available on USA data warehouses and we did not receive any answer to our enquiry by email.
Universities via their Department of General Practice are stakeholders in many projects. This involvement represents GPs' interests, and can also promote GPs' participation and be source of research project proposals, strengthening the GPs' involvement from data extraction up to data mining. Moreover, the partnership with university departments connects GPs with official institutions and with the academic community.
In this review, we identified elements that influence the development and durability of large data collection projects. It will be interesting to extend and deepen our knowledge of these databases: their purpose, content, form (structured or free-text data), quality. Indeed, in the age of Big Data, new methods of data analysis are appearing. Artificial intelligence and its deep learning methods can not only provide clinical decision support systems [46, 47] but also abilities to analyze free-text information from a large amount of data through new natural language processing algorithms.
Furthermore, the management of privacy, which is a major deterrent for GPs, is still to be addressed and should also be studied.
We performed a systematic review with the aim of determining the factors that allow the creation and expansion of routine data collection projects in primary care.
Technological infrastructure influence the outreach of data collection projects, particularly EHR software tools for data extraction. Beyond this first step, the most successful projects also developed comprehensive IT platforms for research purposes.
As GPs are often care pathway coordinators in most countries, primary care data are particularly important for improving healthcare management. Therefore, GPs' investment in these projects is often promoted with financial benefits, training sessions, feedback reports and involvement in research studies.
Finally, we emphasize the concomitant involvement of three main actors in supporting these initiatives: governmental services, academic institutions and software companies. Their partnership seems to be the most effective way to fund long-term and wide range data collection projects.
Several issues still need to be addressed, such as the nature of the data analyzed (coded or free-text data) or the management of privacy, which is a major deterrent for GPs. As the collected data are very sensitive, careful monitoring should be put in place due to the privacy issues at stake. Patients' de-identification should also be studied. Moreover, the project governance and its managers should be extremely transparent to improve GPs' adhesion to routine primary care data collection projects.
The table does not include isolated projects that did not refer to reusable databases, and the TRANSFoRm project, which is a multinational project within Europe based on national databases, such as Nivel in the Netherlands.
We thank the University of Rennes 1 librarians who assisted us in the automated literature search.
We thank E. Andermarcher for critical reading and English correction of the manuscript.
The work presented here was carried out in collaboration by all authors. MG, MC, AC formed the conception and study design. MG, CH and TL did the literature review, and undertook data acquisition and data analysis. MG drafted the manuscript. MC, AC, AB, LF, GB and ER supervised the review method and data interpretation and gave valuable suggestions. All authors read and approved the final manuscript.
Masseria C, Irwin R, Thomson S, Gemmil M, Mossialos E. Primary Care in Europe [Internet]. The London school of economics and political science; Available from: https://www.google.fr/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&ved=0ahUKEwiR-KWckuHMAhVCOMAKHfRYD1IQFggiMAA&url=http%3A%2F%2Fec.europa.eu%2Fsocial%2FBlobServlet%3FdocId%3D4739%26langId%3Den&usg=AFQjCNErLqS7id4v1lAyMUS6NFfayG8uhQ&sig2=HGrl6yQOQFKI0IbxlHL0KQ&cad=rja.


One of my favourite artists. I was given a book of his work for my birthday and these are a few of my favourite portraits. These hardly do justice to his range. Much of his work was deeply shaped by the first world war, of which he was a veteran, and the theme dominates his earlier work. In later years he began painting portraits of both the famous and shadowy characters of Berlin in the 1920s, including the scandal plagued dancer Anita Berber (showed in the first painting).


To ensure our patients have access to the best possible quality care, Missouri Cancer Associates partners with several health care organizations that are as diverse and unique as the medical services we provide. Through shared values and philosophies, these alliances lead to the betterment of the care of all our patients.
The Stewart Cancer Center at Boone Hospital offers a continuum of services, ranging from prevention and detection to diagnosis, treatment, rehabilitative and hospice services.
Missouri Cancer Associates Oncologists are part of the Stewart Cancer Center, offering chemotherapy, blood transfusion, IV fluids, antibiotics, pain management and other cancer treatments and tests.
Contact the American Cancer Society directly by phone (1-800-227-2345) or visit their website at www.cancer.org.
The American Cancer Society has launched a new web tool to make it easier for reporters, the public, and those involved in the cancer fight to find and share cancer statistics. Check it out at CancerStatisticsCenter.cancer.org.
The US Oncology Network is one of the nation's largest networks of community-based oncology physicians dedicated to advancing cancer care in America. Like-minded physicians are united through The Network around a common vision of expanding patient access to high-quality, integrated cancer care in communities throughout the nation. Leveraging healthcare information technology, shared best practices, refined evidence-based medicine guidelines, and quality measurements, physicians affiliated with The US Oncology Network are committed to advancing the quality, safety, and science of cancer care to improve patient outcomes. The US Oncology Network is supported by McKesson Specialty Health, a division of McKesson Corporation focused on empowering a vibrant and sustainable community patient care delivery system to advance the science, technology and quality of care.
We are united in healing with The US Oncology Network. The US Oncology Network unites one of the nation's largest community-based cancer treatment and research networks to expand patient access to high-quality care and advance the science of cancer care. As a member of The US Oncology Network, our physicians and clinicians are united with more than 1,000 physicians and 10,000 cancer professionals from across the country.
Missouri Cancer Associates has partnered with Urology Associates of Central Missouri and are together part of Sentinel Health Group. Urology Associates of Central Missouri's mission is to provide compassionate, quality, state-of-the-art urological care. The medical staff are experts in urology and are able to provide you with advanced treatment options.
Boone Hospital Center is a 397-bed full service hospital located in Columbia, Mo. The hospital provides progressive healthcare programs, services, and technology to people in 25 mid-Missouri counties. Boone Hospital Center is a leader in providing the latest technology, including an innovative surgery center offering progressive endoscopic and laser surgery procedures. The hospital provides numerous community educational lectures and events, centering on disease prevention and wellness. You can contact Boone Hospital Center by phone at 573-815-8000.
The mission of the Vincent P. Gurucharri Foundation is to provide financial assistance to Missouri residents who have limited resources and who are undergoing treatment for cancer. The current list of counties served includes Audrain, Boone, Callaway, Cole, Cooper, Howard, Moniteau & Randolph. The Gurucharri Foundation's goal is to serve people of all Missouri counties. Please contact Steve Isaacs (stevelisaacs@gmail.com) for additional information.
The Siteman Cancer Center was formed from a partnership of the Barnes-Jewish Hospital and the Washington University School of Medicine, creating a leader in cancer treatment, research, prevention, education and community outreach. The four locations in the St. Louis area are staffed with world class doctors, scientists and professionals committed to transforming the patient experience. One way they are doing this is by partnering with the Stuart Cancer Center, which will allow patients to stay closer to home while being treated and add valuable members to each patient's Care Team. This partnership will build a network that can further research and education for physicians, doctors, patients and the public. In 2015, Siteman was awarded an "exceptional" rating from the National Cancer Institute for its programs that offer surgery, radiation, chemotherapy, cancer imaging, genomic and genetic testing, and patient and family services. The Siteman Cancer Center is becoming a world leader in cancer care – one patient at a time.


Tea Service is glad to welcome you aboard. We built an entire world of comfort and customized agency services around you.
Located in Genoa and operating across the entire national territory, TEA SERVICE a long experienced company, offers the best LIMOUSINE SERVICE for top managers, politician and diplomatic staff members, VIP and lovers of comfort, high quality and refined solutions.
Our Private Jet is completely at your disposal, no more time spent waiting at the airport, short time check in. TEA SERVICE also takes care of your personal security renting our cars on request even for your reserved documents.
Our security professionals will assist your daily routine giving you the opportunity to access a more relaxed state of mind mainly reserved to a few. Choosing TEA SERVICE means quality, courtesy, security and flexibility. Relax, Tea Service is your solution.
VIP SERVICES at participating airports of pre-shipment,, FAST TRACK for the security check, ASSISTANCE FOR TAX FREE, ASSISTANCE FOR LANDING AND STORAGE, VIP LOUNGE for the wait, PERSONAL SHOPPER in major Italian cities, DRIVING AND SERVICE HOSTESS for reception at the airport and railway station.
TRANSFER SERVICE for meetings and medical conferences to cooperate with prestigious event agencies. TRANSFER SERVICE PERSONNEL MARITIME embarking disembarking and in collaboration with leading industry agencies.


text:
Organizational Assessment to Help Companies Reinvent their DE&I Initiatives Through Peer Coaching
"Inclusion is the celebration of diversity put into action."
The future of work is here! The unprecedented forces of the pandemic have disrupted and reshaped the way organizations and teams work today. While remote teams have become the new normal; it also means recognizing the need for changing organizational policies and paying attention to crucial issues. One of the biggest challenges faced by organizations, made even more stark by the pandemic, is the need for Diversity and Inclusivity.
The benefits of a diverse, equal and an inclusive work environment are numerous, and these diversity in the workplace statistics can prove it.
More than 50% of current employees want their workplace to do more to increase diversity (Glassdoor)
69% of executives believe that diversity and inclusion are the most critical issues (Deloitte)
Companies with higher-than-average diversity had 19% higher innovation revenues (Harvard Business Review)
Claudia Brind-Woody, VP and MD at IBM said, "Inclusivity means not 'just we're allowed to be there,' but we are valued. I've always said: smart teams will do amazing things, but truly diverse teams will do impossible things."
Evidently, workplace diversity is one of the most crucial elements today. D&I initiatives make workplaces more successful and smarter, promote better employee wellbeing, and lead to increased job satisfaction and employee engagement levels.
How to Cultivate Diversity and Inclusivity
The next biggest question for every organization is to identify where they are on their diversity efforts and how to cultivate a diverse and inclusive environment.
If you are ready to assess your D&I efforts, the most effective tool would be to run a "Organizational Assessment" or what we, at Numly, refer to as a mechanism to understand and bridge the gap between your current state and goals, and how to approach it.
Taking an assessment is a critical step to long-term success, as it provides a data-driven understanding of your current state around diversity and inclusion to guide strategic decisions around resourcing and action planning.
How Numly Helps You
Numly offers the opportunity to provide a Talent Insight Report for your organization, It enables you to understand and measure your employees' skills gaps and get a personalized diversity solution for your organization.
The report provides an insight not only on diversity skill gaps within the organization, but also a detailed analysis and a plan of action to start with.
The first step is to identify your goals towards a diverse workplace and clearly define what diversity, inclusion, and equity would mean to your organization.
Take the simple Organizational Assessment to understand diversity skills gaps, followed by a strategic plan and analysis catered specifically to your enterprise.
Undertake a DE&I Peer Coaching program designed to help grow leaders who can implement collaboration and empowerment within diverse teams and nurture a working environment that treats people fairly and equitably.
Want to reinvent your D&I initiatives? Contact us for a Product Overview or Book a quick demo with us.
Beyond Diversity Training, It's Time for Diversity Coaching
DE&I (Diversity, Equity & Inclusion) delivers more impact than you see!


Question: If John and his ship were struggling to get by with only two people, how are they able to sustain two more people and a bovine?
Alright, guys, I got a little inquiry for before the timeskip. Have we ever finalized what the characters look like before we skip however many years?
I may have a follow-up to this.


New Delhi, India, 30 July 2018: ACREX India will return to Mumbai in 2019 to celebrate its 20th edition, the organisers said in a Press communiqué. "South Asia's largest Exhibition on Air Conditioning, Heating, Ventilation and Intelligent Building" will be held from February 28 to March 2, at Bombay Exhibition Centre, Mumbai, the communiqué said.
Organised by the Indian Society of Heating, Refrigerating and Air Conditioning Engineers (ISHRAE) and NürnbergMesse, the trade fair is endorsed by ASHRAE, the communiqué said.
To date, besides India, the list of participating countries includes Belgium, China, Czech Republic, Egypt, France, Germany, Italy, Japan, Korea, Malaysia, Saudi Arabia, Singapore, Spain, Switzerland, Taiwan, the Netherlands, United Arab Emirates, United Kingdom, Ukraine and the United States, the communiqué said.
Fire & Security India Expo (FSIE) 2019 – previewing fire safety and security solutions.


World renowned biophilic design expert Bill Browning talks to Work in Mind about the economic advantages of bringing the outside in.
The Association of Noise Consultants (ANC) holds its annual national conference on June 6, at the Crowne Plaza Hotel, Manchester City Centre.
EXPLAINER; Health Assured's new office has been designed with the health and wellbeing of its employees in mind.
ThinkingWorkplace productivity: Does your workspace affect your performance?
Natasha Wallace, an organisational wellbeing specialist looks at the impact of space on our workplace productivity.