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Perceptions of general practitioners towards the use of a new system for treating back pain: a qualitative interview study
Changing clinicians' behaviour is recognised as a major challenge. It is clear that behaviour change not only depends on demonstrating the proven effectiveness of clinical interventions; contextual and occupational factors, such as 'change readiness', may be central to their implementation. This paper highlights the context of behaviour change in relation to a healthcare innovation introduced within primary care, highlighting the importance of organisational and interpersonal factors that may help explain the dynamics of implementation.
Qualitative interviews were conducted with general practitioners (GPs) before (n = 32) and after (n = 9) the introduction of a subgrouping for targeted treatment system. GPs were offered an electronic six-item subgrouping tool, to identify patients according to their risk of poor outcome ('high', 'low') in order to help inform their decision making about treatment approaches. Recruitment was based on a 'maximum diversification sample', to obtain a wide representation of views across all five practices. A coding scheme was developed based on the emergent findings, and the data were analysed using 'constant comparison', drawing upon insights and developing connections between themes. We adopted the normalisation process theory (NPT) to explain the uptake of the new system and to examine the relevance of coherence for the implementation of innovations in organisations.
GPs perceived back pain as a low clinical priority, and highlighted the importance of 'practical' and 'relational' coherence in decisions to adopt and engage with the new subgrouping for targeted treatment system. Health professionals often engage in 'sense making' about new innovations to 'road test' their applicability or relevance to daily clinical routines. Low back pain was generally perceived as an 'uninteresting' and clinically unchallenging health problem by GPs, which may partly explain their lack of engagement with the new subgrouping for targeted treatment system. The adoption of this new way of working by GPs was determined by the meaning that they ascribed to it in the context of their daily clinical routines.
We conclude that the key obstacle to implementation of the new subgrouping for targeted treatment system for low back pain in primary care was an initial failure to achieve 'coherence' of the desired practice change with GPs. Despite this, GPs used the tool to different degrees, though this signified a general commitment to participating in the study rather than a deeper attitude change towards the new system.
Interventions aimed at changing the behaviour of clinicians have had limited success
Normalisation process theory (NPT) provides one such framework for understanding why health care interventions are accepted and employed routinely in organisations and others rejected; in particular, examining the social conditions underpinning behaviour change in healthcare settings
'Coherence' in clinical work
It is increasingly clear that changing clinicians' behaviour does not solely depend on the proven effectiveness of the new approach or its dissemination; contextual as well as occupational and professional factors, such as doctors' desire to retain their autonomy over clinical decision making may be critical to any attempts at introducing innovations in health care
However, achieving coherence for new ways of working within organisations does not automatically guarantee acceptance by professionals
Low back pain is the most common reason for consulting a GP among middle-aged people, with approximately 6% to 9% of adults consulting for this condition each year
This study falls within the tradition of organisational change and uptake of innovation studies which adopt qualitative designs that are able to explore complexity, dynamics and multiple perspectives. The interviews were nested within a larger study (the IMPaCT Back ('IMplementation study to improve PAtient Care through Targeted treatment for Back pain') study), which aimed to evaluate the improvement in quality of care for back pain patients following implementation of a subgrouping for targeted treatment system. The GP interviews were embedded within a prospective, population-based, quality improvement study comprising three phases: (a) assessment of GPs' and physiotherapists' attitudes and behaviours regarding low back pain, (b) a quality improvement intervention comprising educational courses, regular feedback sessions, and the installation of computerised and paper-based systems for subgrouping for targeted treatment system, and (c) assessment of GPs' and physiotherapists' attitudes and behaviours regarding low back pain and the subgrouping for targeted treatment system
The IMPaCT Back study was located in five GP practices (and associated physiotherapy services) within one Primary Care Trust. The practices range in terms of size (populations of 4,000 to 24,000) and composition (4 to 12 GPs and a variety of primary care services). Taken together they are representative of similar English general practices. The five practices were identified from one Primary Care Trust, which is part of a larger GP network with which the research centre has collaborative links. The practices were selected on the basis of varying practice sizes (medium and large, but not small), geographical locations (rural and town, but not urban), and willingness to work with the research team on studies investigating musculoskeletal problems. The five practices also represented deprived, affluent, and mixed (both affluent and deprived) patient populations. The practices use various physiotherapy pathways, but, again, represent the national picture.
The literature shows that primary care management of low back pain is inconsistent and outcomes are often poor. Similar patients with back pain in primary care can receive different treatment approaches by GPs, some will be referred on to other clinicians such as physiotherapists, and others not. The new subgrouping for targeted treatment system is intended to assist GPs in the identification of patients at risk of persistent problems, who may benefit from targeted interventions. We envisaged that GPs would find such an approach helpful because it would lead to more systematic identification of patients at high risk of poor outcome, for whom early access to physiotherapy may be more helpful. Conversely, the tool could assist GPs in feeling confident about what they had to offer those patients identified as at low risk of poor outcome, without the need for onward referral. To add to the flexibility of clinical management, GPs were given the option to follow the advice of the tool which included both referral to physiotherapy or best GP practice for back pain; and the option to record their own clinical impression of the patients' risk of poor outcome. GPs and physiotherapists were each given additional training in the new subgrouping for targeted treatment system and the electronic subgrouping tool was tested in one GP practice prior to installing it in the others. The tool had a direct relevance to GPs' daily management of back pain, as it offered assistance with identifying patients for whom onward referral to physiotherapy might be most appropriate. All participating GP practices and GPs were offered the subgrouping tool following an observational phase in which current practice and patient outcomes were monitored.
The intervention
In phase 2 of the study GPs were offered a six-item subgrouping tool, to subgroup patients according to their risk of poor outcome ('high', 'low') in order to help inform their decision making about treatment approaches. Patients at low risk of poor outcome were recommended to receive best primary care advice and management by the GP including red flag screening, reassurance and advice about pain relief, activities and work, supplemented with a brief information sheet, based on recent guidelines
Interviews and recruitment
Here, we only report the interview findings with GPs. We conducted 32 qualitative, semistructured interviews (some by telephone) with GPs at baseline (prior to the introduction of the subgrouping for targeted treatment system) from a total of 65 GPs working at the 5 practices (see sampling procedure below). The telephone interviews were on average shorter than the face-to-face interviews, but covered the same issues. All GPs were invited to participate in the first stage interviews, 32 of whom agreed to an interview. Consequently, 33 GPs either did not reply or declined to take part. These interviews aimed to elicit in-depth information about GPs' experiences of managing patients with low back pain, to help identify the clinical challenges and potential obstacles to change in clinical practice, though they were relatively brief (approximately 10 to 15 min long). In addition, 24 GPs were invited to participate in a further in-depth interview 12 months after the subgrouping for targeted treatment system had been introduced in the practice, and 9 agreed. These second interviews were designed to explore in more detail their experience of using the subgrouping tool and its recommendations about onward referral, its perceived value and fit with their clinical practice and the reasons for use and non-use. We did not contact all of the original 32 interviewees, as several had indicated during the first interview that they did not want to participate in further interviews. A total of 9 GPs finally participated in the second interviews, while the 15 GPs who declined did so without giving a reason. GPs who agreed to a second interview were, on average, higher users of the subgrouping tool (interview participants used the tool with, on average, 47% of their low back pain patients compared to 30% in those who did not participate in the second interviews).
The GPs were selected in two phases: prior to the implementation phase of the subgrouping for targeted treatment system in the study, and after the implementation phase was completed. Recruitment was based on a 'maximum diversification sample', to obtain a wide representation of views across all practices. In the first phase in-depth data on GPs' routines as part of managing patients with back pain was obtained, while the interviews in the second phase focused on decisions to use the subgrouping tool and its recommendations about onward referral in practice, and what impact, if any, the tool had on GPs perceptions and behaviour. Semistructured interviews were organised around the four dimensions of the NPT: 'sense making' about new interventions by professionals, the division of labour in primary care, dissemination and interpretation of knowledge, and the organisational and social context. These four elements provided a framework with which to examine the conditions that make 'normalising work' possible, as well as the factors that impede this process.
All interviews were tape recorded and fully transcribed. Analysis was aided by the NVivo data management system (
GPs' constructions of 'routine' back pain work (interview findings preintervention)
There were no obvious differences in the views expressed by GPs who followed the recommendation of the subgrouping tool and those who did not. In the majority of cases GPs demonstrated a relatively high level of non-adherence to tool use. This finding is strongly borne out in the interviews with GPs who had not used the tool expressing similar views to those who had used the tool, citing the main themes (reported below) as the main reason for their behaviour.
The main focus of these first interviews was on GPs' current approach to back pain, and the issue of routinisation was central to their accounts. The GPs described non-specific low back pain (LBP) as a 'common' complaint that, when compared to the major chronic illnesses such as heart disease or diabetes, had a lower priority for them. GPs followed their own 'script' for all patients with LBP symptoms, allowing them to classify their complaint according to pain severity and follow a management plan which initially included information and exercise advice, followed by subsequent referral to a physiotherapist for those with persistent symptoms. Such a strategy could detract from exploring patients' unique account of their condition and experiences. Most GPs were confident in their ability to match their patients' symptoms with what they perceived to be the appropriate treatment pathway. By and large decision making seemed to be heavily 'scripted'.
GP13: 'Erm, generally I feel OK, in the sense that I am pretty clear about what I want to do with most of the patients. The vast majority, have probably got a self-limiting back problem, so chronic pains, and I have a good idea in terms of medication that I want to intervene with...'
GP14: 'I am confident that I know the right investigations to do and who to send them to for further advice, physios or orthopaedic and I am happy that I can pick out if there is a serious problem, but I am not specialised or I don't have any special interest in the back.'
Most GPs claimed that many patients with low back pain do not require a consultation with a GP, given that the problem is often reasonably self-limiting.
GP24: 'From my point of view I do feel I see a lot of people unnecessarily with simple lower back pain that doesn't necessarily require a GP appointment.'
GPs were reluctant to spend much time managing low back pain, reflected in the limited time they typically spent with patients during consultations, preferring to 'dispose' of patients
GP15: 'I think one of the difficulties I find is, if someone has a chronic back pain, I wish there were occupational physicians that we could say 'oh maybe you could go and see someone if it is affecting your work'.'
GPs also reassured patients that their symptoms were likely to be muscular and therefore self-limiting; a strategy used perhaps to minimise repeat consultations.
GP18: 'When they are in acute pain, when it's just happened, I think a lot of people are thinking, 'oh, I have broken my back', 'I've slipped a disc', or whatever and to be reassured at that point that it is more likely to be muscular and will settle, they are just glad to be reassured, but I always put in the proviso, but if it's not improving, or you get any red flags, to come back straight away.'
Others expressed conflict between their own and patients' expectations of treatment.
GP24: 'I think people are much, they much more want a sort of quick fix and they want a cure, rather than being prepared to take some responsibility, and follow the doctor's advice, and take exercise, lose weight, that sort of thing. So it's a bit frustrating because often you'll see people and they'll say 'Oh I've had back pain' and you'll see that they've DNA-ed (did not attend) the physio you know sometimes, or whatever, so probably for back pain I think that patients are less than committed often, and that's frustrating.'
GP30: '...people who have got chronic back pain want to have a diagnosis, and that's impossible to give most of them and they find it very difficult to accept that what you're trying to do is control and improve symptoms rather than cure them.'
GPs viewed patients' lack of understanding about the typical trajectory of back pain as a hindrance to patient recovery rather than an opportunity to learn about their experiences and how they relate to their perception of the problem and its secondary prevention.
GP7: 'I think the patients often perhaps don't appreciate the natural history [of back pain]... when we are just waiting for the natural history to evolve, isn't accepted very well, very favourably by the patients.'
Wider organisational and professional issues had a significant impact on back pain management, with GPs often reluctant to refer patients to physiotherapy services.
GP11: 'I am sure that physiotherapists are the most appropriate practitioners to treat back pain, so the only thing that stops me is use of resources... yes almost everybody with back pain will benefit from that, but we would run out of physiotherapy resources very quickly when we need it for other things.'
Likewise, the need for orthopaedic services to manage only the most complex low back pain cases resulted in a widespread reluctance by GPs to refer patients; referral in such circumstances could risk damaging professional credibility or even relations with colleagues in secondary care.
GP13: 'the orthopaedic people, who are just quite laid back about everything unless it is a barn door sort of [thing] standing up in front of you, they are just not really interested. So sometimes I think where I get a bit stuck with back pain is when the secondary care services and the registrars, or, they have got quite a high threshold for taking admissions... when you have the acute backs... in an ideal world, with some of those people you want an instant MRI scan to see what is going on and that's just not possible.'
After the first (observational) phase the GPs were introduced to the subgrouping for targeted treatment system and the six-item subgrouping tool through practice-based meetings with clinical opinion leaders and the study research team. Prior to offering the tool to all practices, it was piloted in one practice and found to be simple to use and acceptable, adding no more than 2 min to the consultation. The use of the tool was supported by follow up visits to the practices by informatics staff, to ensure the computer 'pop-up' screens were working and to provide regular feedback (every 2 months) via email and letter about number of patients with low back pain seen and for whom the tool had been used. Offers of additional guidance were made to practice managers and link GPs at each of the participating practices, in these feedback communications. The research team clearly discussed how they would monitor referral rates to physiotherapy and provide additional resource if and where needed. The tool provided the GPs with more systematic information about their patient's prognosis and gave a treatment recommendation based on each patient's subgroup classification, in the hope that patients at risk of poor outcome would receive earlier targeted treatment to help improve their outcome. Subsequent interviews were conducted approximately 12 months after the introduction of the new subgrouping for targeted treatment system in each GP practice.
Practical coherence (interview findings postintervention)
We use the term 'practical coherence' to denote the extent to which clinical routines and behaviours affected GPs' ability to use the subgrouping for targeted treatment system. By 'practical' we refer to those behaviours that enable a task to be managed efficiently, within the constraints of a busy clinic. The GPs perceived the subgrouping tool to have a lower priority relative to other tasks (for example, Quality and Outcomes Framework (QoF), national and local targets), and consequently claimed that time constraints and pressures intrinsic to a busy practice prohibited them from using the tool. Thus, the extent to which the tool could enhance existing clinical routines appeared to strongly influence tool use.
GP35: '...the problem is the time. It's definitely it's playing a major [part] on the issues you know. You're doing something a bit extra on top of what you normally do on a daily basis, which probably already a bit struggling with so timing probably is the most important thing you know.'
GP17: '...it's (the tool) not had very much visibility in the last year (laughing). When I'm talking about a 2 and a half million overspend, I'm afraid the IMPaCT Back study didn't have much of an impact. It might have a million pound public health resource but you know, but at my level it was I'm looking at overspend.'
The following respondent claimed that despite the simplicity of the decision tool, it was rarely used because the task of examining patients and discussing their problems took priority in the context of a busy working schedule.
GP35: 'You've got to examine, you've got to document everything you know, whether they've got any sort of red flags. These all take time... when you've got just about 10 minutes even the seconds is really important and probably that was something that I struggled [with] and if I couldn't really discuss anything in that particular time you know, it was just a timing issue but nothing else...'
A major finding from the interviews was that GPs felt the tool did not account for the complexity of decision making in low back pain. The following GP stressed the impact of patient demand on referral decisions, which is not taken into account by the subgrouping tool.
GP3: 'Whereas, with a patient it's more of, I don't know how to put it really, it's not like a bartering but it is a bit like that you know. They want physio, well sometimes they want physio, and you're thinking well you know, should they have it or not and they may only score one but if they really want physio, they going to get physio because we're here to meet the patient expectations and demand...'
The following GP claimed that medicine was an art, requiring awareness of the human elements of medical care, which the tool could not effectively capture.
GP3: 'It's difficult to say because you see, I'm one of these that thinks that there's an art to general practice and it's more a sort of conversation and a feeling between two people. Now, you can't put feelings into a questionnaire [reference to the tool] so what's right for one, is completely wrong for another and unless you had a questionnaire that was a thousand questions long, you're just not going to capture that, are you? ... It's not a tool that I would want to use within my consultation because it's not how I practice but it's not been obstructive to me.'
Others found that the tool conflicted with established patterns of care, encouraging what they saw as 'inappropriate' referrals to a physiotherapy service that was already struggling with waiting times.
GP10: 'The times I've used it, I've brought it out and said all right to the patient, '[X University] are doing a study let's look at this' you see. So you go through it and then it says 'referral to physio', and so that puts the idea into the patient's mind which you then can't go back on, and I have to say that the very few that I've done, were not people I would have immediately referred to physio, and our physio team can't cope at the best of times you know. They're about a month behind...'
Other GPs found it difficult to alter their routines to fit in with the decision tool, and often forgot or refused to use either the computer or paper-based tool during clinics. Even those GPs that asked for the paper-based tool appeared to struggle to remember to use it with patients.
GP11: 'My major difficulty was remembering to ask the questions because my practice is to enter my notes after the patient has left, so often I would then, you know three or four problems you put them all in, you give the back pain one and the (computer) template throws up and you think oh I've forgot to ask them.'
GPs expressed a general lack of familiarity with the subgrouping tool, claiming that they would have benefited from more frequent contact with the research team for feedback and guidance.
GP17: 'Certainly. I haven't accessed your tool for about a year to be honest, so my familiarity with it, which is part of the reason why last time we spoke, I spoke to someone, I said I would engage more but to be fair, it's probably a lack of familiarity at that point that just hindered the process.'
GP3: 'So that's not been an issue. It's not a time factor; it's remembering to do it if the computer's not prompting you.'
However, involvement in the research led some GPs to reflect on their current practice, which in itself appeared to have a positive effect on behaviour.
GP11: 'There were occasions when it made me rethink and I thought oh well, perhaps I should, because sometimes the process; none of us are consistent and sometimes you don't do the best job so, sometimes you've made a fairly quick decision and, you think you've got to move onto other things, other things are more urgent; more pressing so you haven't necessarily done the best job and the discipline of asking somebody those questions makes you rethink and you think actually perhaps I haven't done as good a job there as I would.'
Several GPs wanted more information about the physiotherapists' new role in the subgrouping for targeted treatment system.
GP13: 'But I wasn't I think initially when [X] may have presented, you know even before recruitment, I think they talked then about what they were looking at but I think it would have been useful as part of Y's and Z's [research team] presentation, to maybe have a physio there saying that this is you know, what we will offer as the intervention.'
GP13: 'Hum, yes in a roundabout way. So I know about the assessments that they [physiotherapists] do and also the psychological therapies that they're sort of putting in but not, I couldn't, if you said to me could you write an essay or a side of A4 of all the things that they do, no I couldn't...'
Relational coherence
Relational coherence refers to the impact of the subgrouping tool on interpersonal relationships between peers. For instance, the use of a new system for targeting and treating patients may affect referral decisions to certain services and directly impact on their workload, or the extent to which tool use is reinforced within an organisation through informal discussion, debate, and (dis)agreements between peers. Such activity may be a prerequisite for the introduction, wider acceptance and 'legitimation' of any new innovation in health care. A central issue affecting the acceptability of the subgrouping tool was the presence or absence of peer communication. Communication between colleagues served two aims: (1) raising awareness (often more important in larger organisations where dialogue between individuals may be less direct), and (2) individual or collective evaluation of a new way of working (integral to its acceptability). The GPs claimed that they generally did not discuss the decision tool or subgrouping for targeted treatment approach with colleagues.
GP11: 'The only time that we've really discussed that has been when you've been to see us.'
Interviewer: '...you ever got chance to have a real good chat with your colleagues as far as what you've been asked to do and how you felt about it?'
GP3: 'I mean we have so many things to discuss, but no, minimal I would say.'
GP10: 'I mean we perhaps talk for about 2 or 3 minutes after you've been to see us (laughing) but then it gets forgotten until the next time if I'm honest.'
Another GP was unclear about his role in the study, claiming that he would like to have received a formal 'contract' with the research team about his role and obligations, which would have improved communication with colleagues.
GP13: 'This is what you're signing up for. Erm, I would have been happy to do it. It wouldn't have been a problem but I would have been much clearer about my role and then I was getting newsletters or feedback from yourselves. I would have understood it was my role to disseminate the information and to discuss it at the, you know, the PLT [Practice learning time] or the lunchtime briefs that we have, and also to share the recruitment figures and to feedback to my partners where we were up to. I think that would have cascaded then.'
GPs discussed the tool together when concerns were raised about the impact that it had on their practice or on the referral rate to physiotherapy. The following GP claimed that discussion with peers resulted in a practice wide consensus that the tool was inappropriate as it recommended that too many patients be referred to physiotherapy.
GP9: 'Certainly in the earlier part of the study, I was referring anybody who came out with a score of 3 or greater but having sort of reviewed that as a peer group of doctors here and discussed whether we should be doing that, we actually came to the conclusion that there are a lot of unnecessary referrals being done purely because of the score 3 or more; ordinarily wouldn't need physiotherapy and probably would benefit relatively little from having it.'
GPs claimed that referral to physiotherapists was conditional on receiving regular feedback on patient progress and timely discharge.
GP13: 'I don't make assumptions about patients but I would [I think] feel more confident about referring patients who I think are going to be left with long-term sick really with an acute presentation so I have a lower threshold for referring patients to physiotherapy, as long as I knew that we were going to get the additional input. I think I'd be reluctant to refer patients with a low threshold who I felt were then going to be attached to physiotherapy, you know, for a long time.'
The danger of overwhelming physiotherapy services with patients presenting with underlying psychological health problems was mentioned by some GPs who felt that any decision instrument that encouraged referral of this nature raised concerns, and was less likely to receive support from GPs.
Interviewer: 'So what sort of clinician do you feel is the most appropriate to deal with patients that consult with low back pain that have the psychosocial issues?'
GP9: 'Traditionally it's been GPs because things like that tend to fall on GPs as sort of the gatekeeper to other services. I think there's no problem I would have with them seeing a physiotherapist as a first port of call but I think the physios would have overwhelming concerns about that because they really don't have the capacity to do that on the NHS.'
A similar view was raised by the following GPs, whose referral decisions were affected not only by the patient's physical complaint but also by the potential burden on physiotherapy services and consequent relations with physiotherapists
GP35: 'There was a constant struggle you know with the physio team because they were under a lot of pressure and you know, maybe as a GP you know, you were a bit under pressure even morally you know should I? Shouldn't I? You know, is it better or not, you know? What's the best basically to do? You know, this kind of struggle that you normally have and in sort of real life, you know sometimes the things that look really really nice on paper you know and in real life you know, sometimes it doesn't work unfortunately.'
GP10: '...I wasn't going to get my wrists slapped, because you do sometimes get your wrists slapped. There's one physio in particular that just bounces them. So you have to justify every referral really...we get messages saying what the wait is for physio and you know, please don't overload us and we're often being told that so I try and manage. I have to say, I try and manage the psychosocial side myself if I'm honest.'
The task of integrating new ways of working in healthcare settings can be challenging
Despite a successful pilot at one practice, the GPs claimed that the subgrouping tool did not integrate well into their everyday management of patients. The organisational pressures affecting the care of patients, such as time constraints presented major obstacles to the use of the decision tool. The perceived motivation of patients to adhere to clinical advice has been shown to affect GPs' decisions to incorporate scientific evidence in practice, as reported previously in relation to smoking cessation
Peer communication also seemed to affect GPs' 'adoptive' behaviour. There is clearly some overlap between the themes reported here, though it is important to point out that there were different dimensions to the pressures prohibiting GPs from routinely using the tool. GPs perceptions about the economic consequences of their referrals to physiotherapy services were a factor affecting whether or not to adopt the tool. Occupational factors, including concerns about the displacement of labour to other groups of workers (in this case, physiotherapists) were another. The risk of undermining professional relationships with peers, for instance, as a consequence of over referral to physiotherapy, was a concern for some GPs. The same GPs incidentally challenged the suggestion that physiotherapists were the most appropriate professionals to manage patients with back pain, particularly those with more complex 'psychosocial' problems; claiming that in such cases patients would ideally require the attentions of a GP, though they expressed this view through a 'managerialist' discourse apparently concerned with the protection of physiotherapy services. This finding might be viewed differently, perhaps as an attempt to protect occupational work boundaries; GPs' reluctance to surrender control over patients could be a strategy aimed at defending their role and location in the status hierarchy. Thus, resistance to using the decision tool in practice may be a symptom of an underlying occupational desire to protect health care jurisdictions
Clinicians have historically been sceptical about the utilisation of formal, rationalistic measures to support the delivery of care, particularly if they perceived a threat to their clinical freedom. Pope
Medicine's claim to autonomy, to set its own standards and control clinical performance without outside interference, is its central characteristic
In summary, low back pain was generally perceived as an 'uninteresting' and clinically unchallenging health problem by GPs, which may partly explain their lack of engagement with it. The adoption of a new way of working by GPs was partly determined by the meaning that they ascribed to it, and any perceived change to the stability and continuity of routine medical work could be met with resistance. Therefore, an appreciation of such routines is the first step towards understanding the perceived acceptance of innovations. The second is a familiarity with how a new way of working may affect work patterns; and, the third is the impact that it may have on interpersonal relationships with peers. Failure to adequately understand all three dimensions may result in largely unsuccessful attempts at integrating new ways of working in the NHS.
Recruitment of GPs into health research is notoriously difficult
Competing interests
The authors declare that they have no competing interests.
Authors' contributions
TS led the analysis and drafted the manuscript. NEF and BNO made a substantial contribution to the conception, design and analysis of the study, and were involved in manuscript development and revisions. All authors read, contributed to, and approved the final manuscript.
We would like to thank the interview participants, Dr Simon Somerville for his helpful comments on an earlier draft, the wider IMPaCT Back study team and the North Staffordshire Primary Care Research Consortium. This work was supported by a grant from the Health Foundation (grant reference number 346/4540) and with a PhD studentship from Keele University.
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Pre-publication history
The pre-publication history for this paper can be accessed here:


text:
Theodoric Neilson "Neil" Ross (born on December 31 1944) is an English voice actor and announcer, born in London, England and now resides and works in Los Angeles, in the United States. He has provided voices (mainly minor characters) for many American cartoons, particularly those based on Hasbro products and Marvel Comics, and numerous video games. Ross has also provided voice roles (such as radio announcers) for many movies, including Back to the Future II, Babe, Quiz Show, and Being John Malkovich.
Neil Ross has announced many Emmy Award ceremonies, and started announcing at the Academy Award ceremonies, beginning with the 75th Annual Academy Awards, in 2003. He has also narrated numerous episodes of A&E's Biography, and many editions of NOVA on PBS (including Mars - Dead or Alive, which was nominated for an Emmy Award in 2004). He is presently the voice of the cable TV channel Game Show Network.
He voiced Shang Tsung (and possibly Motaro) in the animated series Mortal Kombat: Defenders of the Realm.
External links
- Neil Ross Voiceovers - official website
- Voice demos
- Neil Ross on the Internet Movie Database
- Neil Ross interview
- Neil Ross interview on Insomniac Mania

subset: commoncrawl


text:
|Inspector Yellow has been tied up!!
|~ Inspector Dijion
Ruffman The Episode Before The Season 4 Fetch Finale. He was planning to steal The Helmet of Victory and have it in his personal collection.He was portrayed by Robert Fay.
Inspector Dijion Is a Inspector Who Plans To Steal The Helmet Of Victory For Himself And He Used To Be Inspector Yellow Because Of Ropes That Tied Him Up And he Became Inspector Dijion After Inspector Yellow Died.
Inspector Dijion was planning to steal the Helmet of Victory for himself. He meets up with the Fetchers and took The Case from Liza and put it in a secure place within a luggage and while Investigating Dijion looks down at Liza and Issac And There Finding Bottles And When The train Stopped He sends The Fetchers To Look At The Train and When The Train Left Sterling & Brian We're Left behind And It stated Raining. Later In The Train He Contacted Enginering And Tells Him That The Bridge is Up Just Like He wanted And When The Bridge is Lowered By Brian And Sterling Brian Mentioned he was A Criminal Liza,Issac,Tailia And Bethany Chase After Him and Attempted To Run To Old Sturbridge Villiage And Get That Helmet Of Victory But He Got Tripped By Bethany And Was Captured By The FBI, Police, The Fetchers And The Men In Black and was taken to the MIB Headquarters By Agents Kay and Jay For Questioning.
The Defeat
Inspector Dijion was fooled By the fetchers and was arrested by the Men In Black and was taken to the MIB headquarters In New York City for being greedy on the Fetchers And was brought in by Agents Jay and Kay. He remained in MIB headquarters for his attempted theft of the Helmet of Victory and was mentioned in The Season 4 Fetch Finale until Liza was crowned Season 4 Grand Champion and she takes it instead of Himself for a long time afterwards.


text:
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text:
By: Ben Domeier
As it is shown in the picture, Syria has the smallest popultion. We don't use as much water as the other countries.
Population 2014
In this graph, we see that even though Turkey and Iraq have some people in the rural areas, Syria has at least half it's population living on farms and they need water to make food for themselves.
Syria's population hardly grows at all while the other countries flourish and thrive with life.
Our renewable water is very low because we need so much so that we may survive.
The biggest reason Syria needs water from the Tigris and Euphrates is that we don't have much water from inside our own country. No water means no food and no food means death. This is why we ask for so much water, so that we can survive and actually have some because inside our country, we have none.
Even over time, Syria's populations doesn't have a vey big population and it doesn't need as much water as the other countries.


text:
This hotel receives visitors in its ornate lobby with a reception desk (open 24 hours), a safe, lifts and an excellent bar. The hotel comprises 6 floors with a total of 41 rooms and additional facilities include a breakfast room and a public Internet terminal with WLAN access (additional fee applies). It is possible to take advantage of the laundry service (extra charges) and there is a public garage located close by for those arriving by car.
This exclusive hotel is known amongst guests from the fashion and business world and lies to the north of the River Seine, close to Parc Monceau, the Op�ra Garnier and various shopping venues such as the Gal�rie Lafayette and Printemps. Lying on the Champs Elys�es, amidst the picturesque hills of Montmartre, the famous Moulin Rouge is just a short walk away. Various metro stations are a few paces away and it is 20 km to the airport.
The charming rooms have been wonderfully decorated in a romantic style and feature an en suite bathroom with a hairdryer, a desk with a velvet-covered chair, Internet access and a direct dial telephone, all of which make a stay at this hotel most agreeable. Furthermore, there is satellite TV, a minibar, individually controlled air conditioning/ heating, a double bed and a hire safe in each as standard.
Guests may select their continental breakfast from an ample buffet.
It is possible to pay by American Express, Diners Club, JCB, MasterCard and VISA.
Room Facilities:
Direct dial telephone
Satellite cable TV
Internet access
Double bed
King size bed
Individual airconditioned
Individual heating


text:
- Description
Open shelving features two fixed shelves.Adjustable shelf behind louver detailed door.Reversible door opens left or right.Cinnamon Cherry finish.Peppercorn Collection.
1 Linen Tower
Width: 14.75"
Height: 60.625"
Depth: 15.5"
More from this collection: Sauder Bath
- Additional Information
Additional Information
SKU 14200338 MPN 414817 GTIN UPC 042666154253 Brand Sauder Collection Sauder Bath Assemble Length 14.75 Assemble Width 15.5 Assemble Height 60.625 Assembly Required Yes Material MDF Finish Cherry Styles Traditional Shipping Time 1-2 Weeks Free Shipping Yes
- Reviews
Disclaimer: Pictures displayed may include optional products not included in the price. Computer monitors often display color variations. Color swatches are shown if alternative colors are available. Please call us or email us if you have any questions!


text:
|Publication number
|Publication type
|Application number
|Publication date
|Nov 21, 1995
|Filing date
|Jun 20, 1994
|Priority date
|May 15, 1992
|Fee status
|Publication number
|Edward R. Alexander, Ron Goldman, Yajun Li, Simon Bard, Askold Strat, Joseph Katz, Boris Metlitsky
|Original Assignee
|Symbol Technologies, Inc.
|Export Citation
|BiBTeX, EndNote, RefMan
|Patent Citations (1), Referenced by (52), Classifications (24), Legal Events (6)
|External Links: USPTO, USPTO Assignment, Espacenet
This application is a continuation-in-part of application Ser. No. 08/228,172 filed on Apr. 15, 1994, which is hereby incorporated by reference, and which is a continuation of application Ser. No. 07/884,734 filed on May 15, 1992, now abandoned. This application is also related to application Ser. No. 08/173,249, filed Dec. 23, 1993, which is hereby incorporated by reference.
1. Field of the Invention
The present invention relates to a compact, light weight bar code scanning device that can be easily installed in a standard computer terminal connector. More particularly, it relates to a bar code scanning device housed in a standard input/output "I/O") card that is capable of multi-directional scanning and that is connected to a peripheral I/O port. Still more particularly, this invention relates to a multi-directional bar code scanning device housed in a Personal Computer Memory Card International Association ("PCMCIA") standard memory card that is compatible with portable computers and other devices that conform to the PCMCIA standards.
2. Description of Related Art
Laser-based scanner systems are capable of reading indicia having parts of different light reflectivity, e.g., bar code symbols, particularly of the Universal Product Code (UPC) type, at a certain working or reading distance from a hand-held or stationary scanner. Typically, a light source such as a laser generates a light beam which is optically modified and focused to form a beam spot of a certain size at a working distance relative to a housing and is directed by optical components, including a reflecting mirror, along a light path through an exit port of the housing toward a bar code symbol located in the vicinity of the working distance for reflection from the symbol. A photodetector having a field of view extending across and slightly past the symbol detects light of variable intensity reflected off the symbol and generates electrical signals indicative of the detected light. These electrical signals are decoded into data descriptive of the symbol. A scanning component may be situated in the housing, and is operative to either sweep the beam spot in a scan pattern across the symbol, or to scan the field of view of the photodetector, or simultaneously do both. The scanning component is typically a drive motor operatively connected to the reflecting mirror. The scanning component can also be a charge-coupled device (CCD) array.
Many industries, particularly the grocery and food processing industry, designate their products with a unique bar code symbol consisting of a series of lines and spaces of varying widths. Various bar code readers and laser scanning systems have been developed to decode the symbol pattern to a multiple digit representation for check-out and inventory purposes.
Portable scanners that are known in the art consist of a portable computer connected by a cable to a bar code scanner. A signal processor or decoding apparatus can be located in the same housing with the scanner or it may be housed separately. In such cases, a cable connects the scanner to the processor or decoder and then a second cable connects the processor or decoder to the portable computer. In other cases, the signal processing or decoding is performed by the computer. All of these systems are inconvenient to use because of the cables and the separate housings for the scanner and the computer. Moreover, the advantages due to the portability of these units is diminished when the user needs both hands to carry the scanning system. This severely limits the user's ability to perform other functions and the cables are potential safety problems.
Many of the portable scanning systems currently in use require special interface hardware for connecting the scanner to the computer, including adaptors and cables. This adds to the initial cost of such systems and makes them more expensive to maintain.
Attempts have been made to integrate a bar code scanner and computer into a single housing. Such scanning systems have the scanner mounted in a fixed position or adjustable to a limited number of fixed positions. These devices generally have drawbacks, including larger housings that limit portability and high initial cost. This has led to the need for a bar code scanner that is compact and light-weight and easily adapted to use with a portable computer and peripheral computer devices, such as modems.
The Personal Computer Memory Card International Association (PCMCIA), an organization comprised of hundreds of manufacturers of memory cards and related peripheral equipment, has established spatial standards for all circuit boards used in downsized computers. PCMCIA has developed a 68-pin memory card standard for three memory card types as follows:
a. Type I Memory Cards are the same width and length as a common credit card, about 54 mm�85.6 mm, but are thicker than a credit card. The thickness of a Type I card is 3.3 mm (0.130").
b. Type II Memory Cards are used by those companies which are utilizing memory components that are too high to be housed within a Type I card. Type II Memory Cards are also the same overall length and width as credit cards, but have a raised body cross section in the substrate area which gives them an overall thickness of 5 mm (0.195"). The raised substrate areas of these cards are 48 mm in width.
c. Type III Memory Cards are the result of a recent movement sponsored by the Small Form Factor Committee to enable 1.8" Small Form Factor Disk Drives to be plugged into memory card connectors in small portable computer applications. Type III memory cards are the same length and width as Type I and Type II memory cards. However, Type III cards have a substrate area thickness of 10.5 mm. Also, Type III memory cards require a card guide opening width of 51 mm on the header connector to accommodate the slightly wider raised substrate area.
PCMCIA cards enhance the capabilities of a computer by providing standard interface software protocols and hardware interface. They have been used to interface memory, facsimile machines, modems and disk drives with the host computer. The standard connector size makes them compatible with most portable computers and they are designed for easy installation and removal. The present invention advances the art by providing a means for a miniature bar code scanner to be housed in a PCMCIA card and directly interfaced to a computer.
It is therefore an object of the present invention is to provide an inexpensive, light-weight and compact scanning apparatus that is compatible with a portable computing device.
A further object of the present invention is to provide a scanning apparatus that can be connected to a standard PCMCIA port.
A still further object of the present invention is to provide a scanning apparatus housed within a standard PCMCIA memory card.
An additional objective of the present invention is to pivotably mount a scanning apparatus on the exterior of a PCMCIA card.
A further objective of the present invention is to provide a scanner apparatus that can be connected to a computer through an existing PCMCIA compatible port.
In accordance with these and other objects, the present invention is a miniature high speed scanning element integrated within an industry standard PCMCIA card so as to be compatible with portable computers employing the PCMCIA standard. The scanner reads bar code symbols through an aperture in the card housing that is preferably located at the end opposite the PCMCIA connector.
In a preferred embodiment, a scan mirror is mounted on a flexural member upon which a magnet is also mounted. A coil surrounding the magnet is energized with a drive signal, and the magnet and flexural member are caused thereby to oscillate at a resonant frequency, thus causing the mirror to reflect an incident laser beam onto a target bar code symbol.
In an alternative embodiment, the scanner is pivotably mounted on the outside of the PCMCIA card housing and the scan field is adjustable in both the horizontal and vertical directions.
In another embodiment, the scanner uses two mirrors to provide an omnidirectional scan pattern. The first mirror oscillates along one axis and the second mirror oscillates along a second axis.
The novel features which are considered as characteristic of the invention are set forth in particular in the appended claims. The invention itself, however, both as to its construction and its method of operation, together with additional objects and advantages thereof, best will be understood from the following description of specific embodiments when read in connection with the accompanying drawings.
FIG. 1 shows a PCMCIA card with a miniature high speed scan element mounted thereon;
FIG. 2A shows the miniature high speed scanner of the present invention that uses a magnetic field to oscillate the scanning mirror;
FIG. 2B shows a scanner that uses two scanning mirrors oscillated by magnetic fields for omnidirectional scanning;
FIG. 3 is a side view of a PCMCIA card with a scan module pivotably mounted on the exterior;
FIG. 4 is a top view of the PCMCIA card of FIG. 3; and
FIG. 5 is a block diagram showing the elements of the present invention.
FIG. 1 shows a standard PCMCIA card 10 containing the scanning means and the sensor (the "scanner") 12, and the circuit board 14 for processing the signal generated by the sensor. The circuit board 14 in the PCMCIA card housing 10 and the electronic components contained thereon are selected to be compatible with the scanning means that is used. The details for processing the signal generated by the various scanning means and sensors that are used are well known in the art. The connector end 16 of the card 10 consists of a standard 68-pin PCMCIA connector that is compatible with ports on computers and other electronic devices that comply with PCMCIA standards. The card 10 includes a scanning means 12 located opposite the connector end 12. The light beam generated by the scanner 12 passes through an aperture 18 in the card housing 10 and the light reflected from the target bar code or symbol passes through the same aperture 18 and is detected by the sensor. The aperture 18 is preferably located in the end of the card opposite the connector, although it may also be located in the sides or top or bottom surfaces of the card.
The light beam generated by the scanner 12 is directed though the aperture 18 in the PCMCIA card housing 10, reflects off the bar code and is detected by the sensor. The sensor generates an electrical signal proportional to the intensity of the reflected light. The electrical signal is processed by the electrical components on the circuit board 14 in the PCMCIA card housing 10. The output signal that is sent to the host computer is either an amplified analog signal that is further processed in the host computer or it is a processed digitized signal corresponding to the bar code symbol.
FIG. 1 shows a PCMCIA card 10 with a cantilever mode scanner of the present invention. The sensing means provides a compact bar code scanner which in different embodiments is capable of scanning in any one of several modes, a linear scan mode in which it scans along a single axis, an omnidirectional scan mode in which it scans with consecutive scan lines which are angularly displaced relative to each other in an omnidirectional scan pattern, such as a Lissajous scan pattern, or a raster scan mode in which it scans with consecutive scan lines along a first scan axis, and the consecutive scan lines are displaced relative to each other along a second perpendicular axis.
FIG. 2A shows a perspective view of the compact bar code scanner 12 of FIG. 1. A flexural member 22 is supported at one end in a cantilever fashion by a base 20, and mounts thereon a permanent magnet 26 and a scanning mirror 28 which has a scanning beam directed thereon, as from a visible laser diode 24. A drive coil 30 is positioned adjacent to the permanent magnet, and during operation a periodically changing drive signal 32 introduced into the coil 30 induces a periodically changing magnetic field. The periodically changing magnetic field causes the flexural member 22, with the permanent magnet 26 and scanning mirror 28 mounted thereon, to oscillate at the frequency of the periodically changing drive signal, thereby causing a linear scanning of the scanning beam. For efficiency of operation, the resonant mechanical frequency of the flexural member 22 with the scanning mirror 28 and permanent magnet 26 mounted thereon is designed to be at or near the frequency of the periodically changing drive signal.
FIG. 2B illustrates a universal pattern, compact bar code scanning arrangement which operates partially according to the principle of operation of the scanner of FIG. 2A and which is capable of scanning at a relatively high frequency in an x direction, and of not scanning in a y direction for production of a linear x scan, or of scanning at two different resonant frequencies in a y direction, a relatively high frequency or a relatively low frequency. A variety of bar codes and different bar code reading conditions require different types of scan patterns, such as linear scans, raster scan patterns, or omnidirectional scan patterns such as Lissajous type scan patterns. The embodiment of FIG. 2B is capable of producing all of these scan patterns with a relatively simple construction, and includes a double resonant construction for producing either a high or low frequency y vertical scan motion.
In the universal scanning arrangement of FIG. 2B, a light beam from a suitable source such as a visible Laser Diode (VLD) 24 is directed initially onto a high speed horizontal x deflection arrangement 12 which produces high speed x scanning deflections of the beam. The x deflection arrangement 12 can be and preferably is the same as the linear scanning arrangement in FIG. 2A. The resultant x scanned beam is then directed to a vertical deflection arrangement 50, which produces either no, or low or high speed vertical scanning deflections of the beam, provided respectively for raster and omnidirectional scan patterns. The y scanning arrangement 50 includes a flexible base provided with two degrees of mechanical freedom to provide two resonant conditions, a low frequency y scan for raster patterns, and a high frequency y scan for omnidirectional patterns. The y scanning arrangement is driven by the electromagnetic forces produced by a coil 44 which encircles a permanent magnet 42 mounted in the y scanning assembly 50 in a manner similar to that as explained with reference to the embodiment of FIG. 2A.
The y scanning assembly 50 comprises a base 34 which supports a cantilever mounted low frequency flexural strip 36 which supports at its free end a mass 38, which in turn supports a smaller cantilever mounted high frequency flexural strip 40. The flexural strip 40 mounts thereon the permanent magnet 42 positioned within the coil 44, and a scanning mirror 46 mounted at the free end of the flexural strip 40. In this arrangement, the mass 38 and all of the structure mounted thereon (40, 42, 46) can oscillate on the cantilever mounted low frequency flexible strip 36 at a low resonant frequency Frl, and the magnet 42 and scan mirror 46 can oscillate on the smaller cantilever mounted high frequency flexible strip 40 at a high resonant frequency frh. The mass 38 is selected to tune the resonant frequency of the low frequency y drive signal for efficient operation. Similar to the first embodiment, for efficient operation the resonant mechanical frequency of the high frequency y flexural member with the y scanning mirror and permanent magnet mounted thereon is designed to be at or near the frequency of the periodically changing high frequency y drive signal. The resonant frequency of each vibrating assembly is determined in general by the spring constant K of the vibrating member and the mass M and distribution of mass of the vibrating assembly. In the two degrees of freedom embodiment of FIG. 2B, each of the two vibrating assemblies has a different spring constant K (K1 and K2) and a different mass M (M1 and M2) and distribution of mass.
The scanning arrangement is very compact in size. This allows the arrangement to be mounted in a PCMCIA card or as a scan module mounted pivotably and exteriorly to the PCMCIA card.
FIGS. 3 and 4 show the scanner module 94 mounted exteriorly to the PCMCIA card 10 by an articulated joint 90 that permits the light beam generated by the scanner to be rotated in the vertical direction and in the horizontal direction. The signal generated by the sensor is processed by the electronic components inside the PCMCIA card and then sent to the host computer 92. The scanner module 94 houses a scanner and sensor selected from the scanners and sensors disclosed herein. The light beam generated by the scanner and directed at a bar code symbol passes through an aperture 96 in the scanner module 94 and the light reflected from the bar code passes through the aperture 96 and is measured by the sensor. The scanner controls and the sensor signal decoder can be located in the scanner module 94 or they can be located in the PCMCIA card 10 and connected to the scanner and sensor located in the scanner module 94 by interconnecting wires.
FIG. 5 shows a block diagram of the present invention. The microprocessor 310, scanner controls 320, the scanner 350, the sensor 330, and the decoder 340 are housed in the PCMCIA card and connected to a host computer 300. In another embodiment, scanner 350 and the sensor 330 are exteriorly mounted to the PCMCIA card.
For any of the embodiments described above, the PCMCIA card can by powered through the host computer or have an integral power source so that an external power supply is not required.
While the invention has been illustrated and described as embodied in a bar code scanner housed in a PCMCIA card, it is not intended to be limited to the details shown, since various modifications and structural changes may be made without departing in any way from the spirit of the present invention.
Without further analysis, the foregoing will so fully reveal the gist of the present invention that others can, by applying current knowledge, readily adapt it for various applications without omitting features that, from the standpoint of prior art, fairly constitute essential characteristics of the generic or specific aspects of this invention and, therefore, such adaptations should and are intended to be comprehended within the meaning and range of equivalence of the following claims.
What is claimed as new and desired to be protected by Letters Patent is set forth in the appended claims.
|Cited Patent
|Filing date
|Publication date
|May 14, 1993
|Aug 16, 1994
|Gambro Ab
|Set of tubes for peritoneal dialysis
|Citing Patent
|Filing date
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|Apr 29, 1994
|Sep 2, 1997
|Tps Electronics
|PCMCIA interface card for coupling input devices such as barcode scanning engines to personal digital assistants and palmtop computers
|Apr 25, 1995
|Sep 23, 1997
|Tps Electronics
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|Jun 20, 1996
|Jan 13, 1998
|Symbol Technologies, Inc.
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|Jan 22, 1996
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|Tohken Co., Ltd.
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|Laser based PCMCIA data collection system with automatic triggering for portable applications and method of use
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|Khyber Technologies Corporation
|Card shaped computer peripheral device
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|Fajkowski; Peter W.
|Method and apparatus for coupon management and redemption
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|Symbol Technologies, Inc.
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|Canon Kabushiki Kaisha
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|Motorola, Inc.
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|Securized, multifunction, acquisition and processing terminal usable in the banking sector, in connection with games and in the electronic management of documents
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|University Of South Florida
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|Lucid, Inc.
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|U.S. Classification
|235/462.36, 235/462.41
|International Classification
|Cooperative Classification
|European Classification
|Nov 14, 1994
Owner name: SYMBOL TECHNOLOGIES, INC., NEW YORK
Free format text: ASSIGNMENT OF ASSIGNORS INTEREST;ASSIGNORS:ALEXANDER, EDWARD R.;GOLDMAN, RON;LI, YAJUN;AND OTHERS;REEL/FRAME:007213/0499;SIGNING DATES FROM 19941101 TO 19941107
|May 10, 1999
|Fee payment
Year of fee payment: 4
|Apr 30, 2003
|Fee payment
Year of fee payment: 8
|Jan 5, 2005
Owner name: JPMORGAN CHASE BANK, N.A., NEW YORK
Free format text: SECURITY INTEREST;ASSIGNOR:SYMBOL TECHNOLOGIES, INC.;REEL/FRAME:016116/0203
Effective date: 20041229
|Apr 27, 2007
|Fee payment
Year of fee payment: 12
|Dec 3, 2010
Owner name: SYMBOL TECHNOLOGIES, INC., NEW YORK
Free format text: RELEASE BY SECURED PARTY;ASSIGNOR:JPMORGANCHASE BANK, N.A.;REEL/FRAME:025441/0228
Effective date: 20060901


text:
22 Years Later, A Role Emerges
When Miramax reissues Francis Ford Coppola's ''Apocalypse Now'' next week, it will be a very different film from the one audiences saw in 1979 -- and for many who have seen the new version, a much better one.
Mr. Coppola and his editor, Walter Murch, have added 49 minutes to the film. The most significant addition is a long sequence on an isolated plantation operated by an armed French clan. Martin Sheen and his men spend a night there away from the carnage of the Vietnam War on their way upriver for a fatal rendezvous with the renegade Colonel Kurtz (Marlon Brando).
''It had begun as a war movie and turned into a more operatic, philosophical film,'' Mr. Coppola said at this year's Cannes International Film Festival, where the new version had its premiere. ''We were very much under the gun and didn't want it to be as big a flop as everyone was saying it was. The French plantation scene was long, and to the audience of that day, who were expecting more of a 'Guns of Navarone' kind of movie, it seemed like a left turn just when the movie was getting to an ending.''
''I was very sad when it was cut,'' said Aurore Clement, the French actress who, playing the opium-addicted daughter-in-law of the plantation owner, was the focus of the deleted sequence. ''It was only my second movie, after ''Lacombe, Lucien,'' and it was devastating.''
The film had one happy side benefit for Ms. Clement: it was on the set of ''Apocalypse Now'' that she met her future husband, Mr. Coppola's longtime production designer, Dean Tavoularis.Continue reading the main story
''Afterward, I didn't see him for one year, while Francis was finishing the movie,'' she said. It was at the Cannes Film Festival in 1979, where ''Apocalypse Now'' was shown as a work in progress, that Ms. Clement and Mr. Tavoularis cemented their relationship.
''When Francis decided to put back the scene, it was like being welcomed back to my real family,'' Ms. Clement said. ''It was like going back to the house of your father.''
The Benefits of Iceland
On one of this summer's hottest days, Baltasar Kormakur could be found sitting in the lobby of the SoHo Grand Hotel wearing leather pants.
Mr. Kormakur is from Iceland, which goes a long way toward explaining his odd sartorial choices.
Mr. Kormakur was visiting New York on behalf of ''101 Reykjavik,'' an offbeat romantic comedy that he wrote and directed (from a novel by Hallgrimur Helgason).
The film, which opened on Wednesday at Film Forum, is the story of a Reykjavik slacker (Hilmir Snaer Gudnason) who discovers that he has slept with and perhaps impregnated his mother's lesbian lover, a visiting teacher of flamenco dance (played by the Spanish actress Victoria Abril).
''Sometimes, in the winter, you wonder who got the crazy idea to settle down in Iceland,'' Mr. Kormakur said, ''where you have two hours of light, and snow always blowing in your face. But in the summer, when it is light and you are riding in the highlands, you understand everything.''
The baroque plot has some personal resonance for Mr. Kormakur in that his father was a Spanish painter who went to work in Iceland's herring industry, met Mr. Kormakur's mother in a cafe and married her 18 days later.
''I'd say that the film is autobiographical, except that my mother is not a lesbian,'' Mr. Kormakur said. ''At a certain point, there was a lesbian flamenco dancer teaching in Reykjavik, and actually she made a pass at my girlfriend at the time. So that's where I got the idea.'' (In the novel, the character is a visitor from Iceland's glacial north.)
''I was looking for an actress around 40 with a very strong sexual charisma,'' Mr. Kormakur said, explaining his choice. ''We have to believe that both a 20-year-old son and a 50-year-old mother -- and all the audience -- could fall in love with her. There weren't many who came to mind, but I have been a fan of Victoria Abril for a long time, and I was able to contact her through her agent.''
According to Mr. Kormakur, Iceland's unusual environment does offer some advantages to filmmakers: ''We shot the film in two parts -- the night scenes in the winter, when it is dark all the time, and the day scenes in the summer, when it is always light. That way, we got unlimited working hours.''
Just Like Brothers
Scott McGehee and David Siegel, who together produced, wrote and directed the independent thriller ''The Deep End'' (opening on Aug. 8 in New York), are unusual among filmmaking duos in that they are not brothers, contradicting the tradition of the Coens, the Farrellys, the Weitzes and the Wachowskis.
''We're soul brothers, man,'' joked Mr. McGehee, whose first film with Mr. Siegel was the well-received 1993 ''Suture.'' ''It's a funny thing,'' Mr. Siegel added. ''It's been a little more than 10 years that we've been doing this together. We're so bound up with each other in terms of work that I don't think either one of us could imagine doing it alone now. We rely on each other creatively. . . .''
''In a way that is very rewarding,'' Mr. McGehee said, finishing his partner's sentence. ''We actually do have a fair amount of conflict when we're writing, but by the time we're on the set we agree on pretty much everything.'' ''The Deep End'' stars the British actress Tilda Swinton as a Lake Tahoe housewife who fears that her gay son is covering up the killing of his lover. A charming blackmailer (Goran Visnjic) arrives on the scene, and an unlikely romance develops.
Cinephiles will recognize this plot as the basis of Max Ophuls's 1949 film noir ''The Reckless Moment,'' which starred Joan Bennett and James Mason. But there is one major twist: in the Ophuls film (and the Elisabeth Sanxay Holding story upon which it is based), it's the heroine's daughter who's in trouble.
''We both really loved that movie,'' Mr. Siegel said, ''but the idea of remaking it never crossed our mind. It was a couple of years later that one of us read the book out of curiosity, and the idea started germinating that there might be an interesting new adaptation that involves the sexuality of the child.''
''We were superconscious of working in the shadow of Ophuls, but we really tried to find our own voice,'' Mr. Siegel said. ''The lake was the real touchstone for us, the way the water could work as a loose but controlling metaphor, the way the colors of the lake could set the color palette for the movie.''
''We wanted the relationships in the family to be the guide for the movie,'' Mr. Siegel elaborated. ''The brightness of the film, the softness of the film, the way the colors work in the film come from that desire to keep the emotional relations the heart of the story.''Continue reading the main story


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by Beth
Lord, I love O'Brian. Lord, I love Donny too. Lord, please help me. I really like 'em. Gig 'em horns!? I love you Biggie. Big Buddy. Please help me to do good. Please help me to do good as a person. Lord, I really thank you for this. I need your help. I am dealing with needing you and I pray that you will fix some things for me. You are really the Great deity. God bless you. I am encouraged, and I pray that you hear me and that you hear that part, that I am encouraged. Big Buddy, I really appreciate you. I pray, Big Buddy, that you hear me pray that I really appreciate you. Good Big One. You are Big Bud. Good. Now, I pray that you bless O'Brian. Lord, I pray that he is not suffering. Lord, I pray that you help him if that is what he needs. I pray for a better understanding of O'Brian Lord, if you see it to be a good thing. I really appreciate you and your helping me with my O'Brian Experience, aka, the Vivitar Experience O'Brian '99. Which is of course as you know the '012 version. God bless you Big One. I pray that you are blessed today El Big Senore. You are a nice Deity. Lord, I pray that you know that I am happy today. I am feeling better now, that I have prayed. Please remind me to pray. You are gracious. You are magnificent. You are wonderful. Lord, I pray that you are powerful and omnipotent. I pray that you are omnipotent Lord. God bless you. I pray for Mary also Big Shiny One. I pray that O'Brian get it done, or get good, or become who you want him to be and I pray that he do what you want him to do. Lord, I am most thankful for your gracious affirmation of my faith. You special big wonderful being. I pray Lord, that you know that I love you and that I love you. I also pray that you explain that last part, because I can say that I don't understand it. Please free me from the devil and sin, in this regard, as I have aforementioned. I love you. What is an O'Brian father. I pray that you tell me what O'Brian is. I pray that you teach me, and lead me, and guide me in a good way on this here topic. Big Shiny, I pray that you keep me safe and free from evil in also Don's case. I pray that you help me understand that also, if you think it best in your will, etc. Please help me to be free from strife, and evil and confusion, if it is your will with regard to these men. I love you. In Jesus Name Amen.
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Welcome to a world where stories can be as deadly as poison, and falling in love can get you killed. YA fantasy debut THE LAST NAMSARA by Kristen Ciccarelli is a heart-soaring, brilliant coming-of-age story about courage, loyalty and star-crossed love, set in a kingdom that trembles on the edge... CONTINUE READING
Happy Publication Day 13th July 2017!
It's publication day once again! We have some brilliant paperback titles, including a remarkable collection of short stories from one of our greatest science-fiction authors, Stephen Baxter, as well Beaulieu's prequel to his highly acclaimed Twelve Kings. PC Grant makes a return in Aaronovitch's bestselling series, and the perfect introduction... CONTINUE READING
Happy Publication Day 15th June 2017!
It's publication day! Get your hands on these brilliant new releases from Stephen Baxter, Elizabeth May, and Nalini Singh, as well paperbacks from the incredible Alastair Reynolds, Stephen Donaldson, and Edward Cox. Xeelee: Vengeance by Stephen Baxter One of the world's bestselling science fiction authors returns to the series... CONTINUE READING
The Entire Works of David Gemmell are Coming to Audio for the First Time!
Orion Audio and Hachette Audio have jointly acquired world audio rights from Anna Carmichael and Ben Fowler at Abner Stein (on behalf of the Howard Morhaim Literary Agency) for the full works of fantasy legend, David Gemmell. A perennial Sunday Times bestseller, Gemmell was a staple of the UK fantasy... CONTINUE READING
Happy Publication Day 8th June 2017
It's publication day! We are incredibly excited to announce a classic addition to the Masterworks list from one of the greatest science fiction writers of them all, H. G. Wells, as well as all the stories set in award-winning author Ursula K. Le Guin's fictional European nation of Orsinia, gathered... CONTINUE READING
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We are thrilled to welcome Alex Lamb back to the Gollancz blog for a very special guest post. Alex is the author of the Robotoeer trilgoy (Roboteer, Nemesis, Exodus). Today, Alex takes us behind the scenes of the SETI project and talks about the real life science that influences his... CONTINUE READING
Cover Reveal: THE SMOKE
Behold this gorgeous cover! Simon Ings' latest SF novel The Smoke is about love, loss and loneliness in the capital city. So it's the perfect thing to read on your commute, wherever your travels might be taking you. From the acclaimed writer of Wolves, The Smoke is an incredibly beautiful... CONTINUE READING
Read an exclusive extract from Ed McDonald's BLACKWING!
We are thrilled to share with you an exclusive extract from Ed McDonald's debut novel, Blackwing. Out in bookshops on the 27th July, Blackwing will be the book everyone is talking about this summer. The republic faces annihilation, despite the vigilance of Galharrow's Blackwings. When a raven tattoo rips itself... CONTINUE READING
Proof Cover Reveal: THE LAST NAMSARA!
We are ridiculously delighted to reveal the truly gorgeous proof coverr for Kristen Ciccarelli's mind-blowing amazing YA fantasy debut, THE LAST NAMSARA, which has been designed by the incredibly talented Dan Smith at Bionic graphics. This is a novel that will squeeze your heart into pieces while simultaneously making it... CONTINUE READING
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It's a very special publication day for us as we get to bring you a never-before-seen novel from the legendary David Gemmell! Not only that, we've got two excellent science fiction novels from Justina Robson and Alex Lamb out in trade along with two fantastic paperbacks from Alastair Reynolds and... CONTINUE READING


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I have similar devices on the network that have added in prior inventories, I have added two more and I can ping those devices, but the network inventory is not added them. What settings can I look at to make sure these devices are added? I know it is scanning the ip range.
This topic was created during version 1.7.
The latest version is 7.5.00101.
3 Replies
Jan 9, 2008 at 12:19 UTC
Greetings John,
Test your connectivity by typing the following command from the command prompt (Start Menu -> Run -> cmd.exe). This procedure needs to be performed from the computer that Spiceworks is installed on, and to the remote computer.
wmic /user:USER_NAME /password:USER_PASSWORD /node:IPADDRESS systemenclosure get serialnumber
USER_NAME = the domain account (DomainName\UserID) or local account (UserID) entered in Spiceworks
USER_PASSWORD = the password for the above account
IPADDRESS = ip address of the unknown device
This should return the serial number of the machine that you provided an IP address for.
The following examples are successful wmic responses:
Also, please do a forward and reverse lookup to the machine in question
nslookup IPADDRESS
nslookup HOSTNAME
NOTICE: Just tell me if the commands were successful, do not paste in any network specific data here.
Jan 11, 2008 at 3:25 UTC
the nslookup states can't find x.x.x.x : non existent domain. This is for both same type devices that are currently in inventory and the ones that don't want to add. (x.x.x.x = ip address) These devices are not windows computers, but thin clients. Normally spiceworks does show these as unknown devices, but does find them.
I installed spiceworks on my workstation and it does find these devices; as additional trouble shooting.
On the server that this was originally installed on it does not. I double checked route statements, etc..like I stated I can ping.
Using wmic I see ERROR: code=0x800706ba rpc server is unavailable; facility = win32
The next part of my question...if my workstaion found the device, can I copy that or insert/import that device on my server that normally houses spiceworks; as a work around?
Jan 16, 2008 at 3:34 UTC
I apologize for the delayed response.
1. You will need to manually reclassify the Thin Clients. In many cases they are detected using Port 9100 (Printer) devices.
We are also investigating ways that we can detect and classify these properly as workstations. For information on reclassifying the devices manually please see:
We are also investigating ways that we can detect and classify these properly as workstations.
2. John2517 wrote:
>>>>The next part of my question...if my workstaion found the device, can I copy that or insert/import that device on my server that normally houses spiceworks; as a work around?
I'm a little confused by what you're asking. You can move your entire database.
Also, for the RPC error your received, is that when you tried to connect to the thin clients or another device?
This discussion has been inactive for over a year.
You may get a better answer to your question by starting a new discussion.


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We stayed for 4 nights. The staff were incredibly welcoming and friendly, and helpful in organising transport and a day trip. The central location in the old town area means that it is easy to see many of the local sights on foot.
As can be seen from the photos, the whole hotel and bedrooms are stylishly decorated and furnished, although the low level of lighting on the staircase and some other areas does mean that caution is needed at night – my wife tripped on a couple of occasions on the staircase. There is no lift – our room was on the second floor. Also, our room had no desk/table you could sit at, and only one chair between us. However, these are quite minor drawbacks – we really enjoyed our stay. A plus for us was that there were both a kettle and filter coffee maker in the room. WiFi was free and quite fast compared with other hotels we stayed at.
The breakfast (available from 6.30am) was a mixture of international buffet options, plus hot food to order. We ate in the hotel restaurant most evenings, and the food was excellent, although they ran out of the less expensive white wine options on the wine list. At breakfast and dinner, service was fast and friendly. The upstairs bar, above the restaurant, was largely deserted and while open to the public (as is the restaurant) was a bit half-hearted in terms of drinks and service. There is a delightful, air-conditioned reading room area above reception – we were sorry that we were too busy during our short stay to make use of it.
There are bars, and cheap eating options in the street, opposite the hotel. On Sunday nights the street is closed to traffic from about 5pm and becomes a "walking street" market. Stalls and crowds appear from nowhere and there is a huge variety of goods on sale – this is really worth experiencing, so stay a Sunday night if you can.
If we ever return to Chiang Mai, we would certainly stay here again.
- Official Description (provided by the hotel):
- Uncomplicated. Inspiring. You. A low-rise hotel comprised of 41 rooms located in the heart of the city on Ratchadamnoen Road. The Residents' Lounge to welcome all of our guests is located in the refreshed past residence of Chiang Mai's governor with a modern Thai accented interior design in keeping with its heritage setting. Only 20 minutes drive from Chiang Mai International Airport and minutes walk to the city's famous walking streets. Unique concept of service such as 24 hour use of room, breakfast whenever/wherever and U Choose Programme. ... more less
- Reservation Options:
- TripAdvisor is proud to partner with Orbitz, Travelocity, Expedia, Booking.com, Hotels.com, Agoda, Hotwire, TripOnline SA, Cancelon, getaroom.com and HotelQuickly so you can book your U Chiang Mai reservations with confidence. We help millions of travelers each month to find the perfect hotel for both vacation and business trips, always with the best discounts and special offers.
- Also Known As:
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Britain's anti-terror laws are in danger of catching journalists, bloggers and other people they were never intended to cover, an independent watchdog warned today.
David Anderson QC, the country's reviewer of terrorism legislation, said the legal definition of terrorism was too widely drawn and the current laws were inhibiting free speech and gave too much power to individual police officers and to the Government.
He said there had been a degree of "creep" in Parliament in recent years that could be reversed without diminishing the impact on legislation.
Speaking on the BBC Radio 4 Today programme he said : "The problem is that our definition has begun to catch people that it was never really intended to catch.
"I give credit to the prosecuting authorities and to the police and indeed to ministers because I don't think they very often abuse or stretch the very wide discretions they are given under the Act.
"The problem is more that people who should never get caught by these laws just get worried that they might be and that could have the effect of restricting the way that they go about their business."
He referred to the case of David Miranda - the partner of journalist Glenn Greenwald who was involved in publicising the disclosures of former US intelligence contractor Edward Snowden - who was detained at Heathrow Airport for several hours on suspicion that he was carrying stolen documents.
"I would certainly accept that the police ought to have the power in those circumstances to stop somebody and detain them and see what's going on. What I think is more difficult to defend is the use of anti-terrorism laws for that purpose," Mr Anderson said.
Mr Anderson, who publishes his annual report today, warned that the public would only continue to accept the legislation if they were sure it was genuinely needed.
"You could look at the example of journalists and bloggers, for example, who can be considered terrorists, it seems, if they are seeking to influence the Government and if their words endanger life or create a serious risk to public health or safety. Foolish or dangerous journalism is one thing, terrorism is another," he said.
"I think the problem there is the way the bar is set. It is enough that you are trying to influence the Government for political reasons. In most other countries you need to have to intimidate the government or coerce the government before you can be a terrorist."
In his report he gives three examples of how the terror laws are too widely drawn.
He says the "exorbitant use" of powers by police and prosecutors in Britain is rare. But he says the "overbroad laws" give too much power to police and the Government.
He says: "They make people more cautious than they need to be in what they say and what they write. And they encourage cynicism about special powers which are necessary for dealing with terrorism, but which will fall into disrepute if they are perceived to extend more widely."
The laws were so broad they could catch a campaigner who voices a religious objection to vaccination.
On hate crimes he said the law makes a terrorist of a schoolboy who threatens to shoot his teacher on a fascist website, or of a racist who throws a pipe bomb. Both people are obvious criminals, he says but "no purpose is served by characterising them as terrorists."
He also criticises more recent legal phrases such as "terrorism-related activity" which he says are too broad a definition.Reuse content


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Authentication of Official Documents II
The "Authentication of Official Documents II" course is designed to provide official documents translators with an understanding of their role in the translation and preparation of official documents. At the end of this course, official document translators will have learned about their role in the authentication of official documents process, as well have in-depth knowledge as to how official documents must be prepared in order to be accepted in foreign countries.
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President Hosni Mubarak will be driven from power in Egypt. Everything else about the Egyptian uprising is difficult to predict, including the country's new leadership, the Egyptian economy, the Obama administration's position, and the effects on Israel and the Palestinians, both anxious about Egypt for their own reasons. Putting aside these future quandaries, the Egyptian people are throwing off a regime that has long stood for domestic repression and stagnation. Waseem Wagdi, an Egyptian living in London, made a passionate statement about his country's yearning for freedom during a protest this past Saturday at the Egyptian Embassy in London:
Tuesday, February 1, 2011
Waseem Wagdi, Egyptian Protester At The Egyptian Embassy, London
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Posted by Jeff at 12:15 AM
Labels: Egyptian uprising, Waseem Wagdi
1 comment:
- Chudexs said...
things that happened in Egypt it is only fitting in my opinion, a democratic president, but he wanted the monarchy then it takes the struggle of his people to stop this behavior. possible side like this many will take advantage of things happen but do not underestimate this is evidence that the East has risen and prove the truth that has been written from time immemorial..
- February 1, 2011 at 10:13 PM
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Chennai: Despite being the chairman of selectors of Indian team, Krishnamachari Srikkanth is keen on victory of his home team Chennai Super Kings. Former Indian captain is backing Chennai Super Kings to go to the distance this time and win the IPL title on Sunday.
Chennai Super Kings, lead by Indian skipper Mahendra Singh Dhoni, finished second in the first edition of the IPL.
But the former Indian opener feels the team has what it takes to finish off the job this time around.
IPL 2009 - Results | IPL 2009 Points Table | Orange - Purple Cap
"I am backing Chennai Super Kings to reach the final and then complete the unfinished business of the last season. I hope they do it," said the 49-year-old who considered Dhoni, Anil Kumble, Yuvraj Singh and Shane Warne among the better captains in this IPL.