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Links of London there have been varying approaches to developing electronic care records systems. In 2002 the government in England opted for a top-down, government-driven strategy that used standardised, commercial software applications. In contrast, Australia and the USA have chosen more devolved strategies. The nationwide implementation of electronic health records in England, known as the Links of London Disc charm Care Records Service, is the cornerstone of the (GBP)12.7bn National Programme for IT. Given the planned widespread cuts to public spending and government plans to restructure the NHS in England, the authors anticipate major policy revisions affecting the National Programme. The priority, according to the authors, is to clarify the type and scale of nationwide electronic health records that are now wanted and affordable. The authors argue that the English experience shows that having a 'vision' of nationwide electronic health records can be successful in kick-starting such an ambitious programme, but realising this vision is Links of London Back to School Chubby Red Pencil Charm to be a process that evolves over many years, perhaps even decades. They conclude that "while there is no clear evidence as yet that a middle-out approach will achieve the goal of large scale nationwide electronic health records, international experience, including England's, suggests that neither a purely top-down nor bottom-up approach will likely do so." Keywords: BMJ-British Medical Journal, Electronic Medical Records, Links of London Back to School Chubby Blue Pencil Charm (see also Investors and lenders are getting creative as Europe's lingering credit squeeze puts pressure on banks to refinance a mountain of debt over the next few years. One sign of this: Germany's Eurohypo AG has taken control of an office development at 6 Bevis Marks in London from Spanish developer Monteverde and is in talks to build on the site. Rather than sell the development outright, and be forced to book the losses, Eurohypo is retaining a link to the property by forming a joint venture that lets it share in future profits from the project. In another example of investor creativity, mezzanine-debt lenders are beginning to re-emerge.