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Butalbital, acetaminophen, and caffeine combination is used to relieve symptoms of tension (or muscle contraction) headaches.
Butalbital belongs to the group of medicines called barbiturates. Barbiturates act in the central nervous system (CNS) to produce their effects.
Acetaminophen is used to relieve pain and reduce fever in patients. It does not become habit-forming when taken for a long time. But acetaminophen may cause other unwanted effects when taken in large doses, including liver damage.
When butalbital is used for a long time, it may become habit-forming, causing mental or physical dependence. However, people who have continuing pain should not let the fear of dependence keep them from using narcotics to relieve their pain. Physical dependence may lead to withdrawal side effects if treatment is stopped suddenly. However, severe withdrawal side effects can usually be prevented by gradually reducing the dose over a period of time before treatment is stopped completely.
Caffeine is a CNS stimulant that is used with pain relievers to increase their effect. It has also been used for migraine headaches. However, caffeine can also cause physical dependence when it is used for a long time. This may lead to withdrawal (rebound) headaches when you stop taking it.
This medicine is available only with your doctor's prescription.
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Appropriate studies have not been performed on the relationship of age to the effects of butalbital, acetaminophen, and caffeine combination in children younger than 12 years of age. Safety and efficacy have not been established.
Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of butalbital, acetaminophen, and caffeine combination in the elderly. However, elderly patients are more likely to have age-related kidney problems, which may require caution and an adjustment in the dose for patients receiving butalbital, acetaminophen, and caffeine combination.
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Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.
Using this medicine with any of the following is usually not recommended, but may be unavoidable in some cases. If used together, your doctor may change the dose or how often you use this medicine, or give you special instructions about the use of food, alcohol, or tobacco.
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This medicine may be habit-forming. If you or your child feel that the medicine is not working as well, do not use more than your prescribed dose. Call your doctor for instructions.
Check with your doctor right away if you or your child have pain or tenderness in the upper stomach, pale stools, dark urine, loss of appetite, nausea, unusual tiredness or weakness, or yellow eyes or skin. These could be symptoms of a serious liver problem.
Serious skin reactions can occur with this medicine. Check with your doctor right away if you have blistering, peeling, or loose skin, red skin lesions, severe acne or skin rash, sores or ulcers on the skin, or fever or chills while you are using this medicine.
This medicine may cause serious allergic reactions, including anaphylaxis. Anaphylaxis can be life-threatening and requires immediate medical attention. Call your doctor right away if you or your child have a rash, itching, hoarseness, trouble breathing, trouble swallowing, or any swelling of your hands, face, or mouth while you are using this medicine.
This medicine may make you dizzy or drowsy. Make sure you know how you react to this medicine before you drive, use machines, or do anything else that could be dangerous if you are dizzy or not alert.
This medicine will add to the effects of alcohol and other CNS depressants (medicines that can make you drowsy or less alert). Some examples of CNS depressants are antihistamines or medicine for allergies or colds, sedatives, tranquilizers, or sleeping medicine, other prescription pain medicine or narcotics, medicine for seizures or barbiturates, muscle relaxants, or anesthetics, including some dental anesthetics. Also, there may be a greater risk of liver damage if you drink three or more alcoholic beverages while you are taking acetaminophen. Do not drink alcoholic beverages, and check with your doctor before taking any of these medicines while you are using this medicine.
Before you have any medical tests, tell the medical doctor in charge that you or your child are taking this medicine. The results of some tests may be affected by this medicine.
Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur:
Get emergency help immediately if any of the following symptoms of overdose occur:
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
Portions of this document last updated: April 01, 2024
Original article: https://www.mayoclinic.org/drugs-supplements/butalbital-acetaminophen-and-caffeine-oral-route/description/drg-20075393


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Israel's Kingdom Blessing
(2 Samuel 23:1-7)
1{{A Song [or] Psalm of David. }} O God, my heart is fixed; I will sing and give praise, even with my glory.
2Awake, psaltery and harp: I [myself] will awake early.
3I will praise thee, O LORD, among the people: and I will sing praises unto thee among the nations.
4For thy mercy [is] great above the heavens: and thy truth [reacheth] unto the clouds.
5Be thou exalted, O God, above the heavens: and thy glory above all the earth;
6That thy beloved may be delivered: save [with] thy right hand, and answer me.
7God hath spoken in his holiness; I will rejoice, I will divide Shechem, and mete out the valley of Succoth.
8Gilead [is] mine; Manasseh [is] mine; Ephraim also [is] the strength of mine head; Judah [is] my lawgiver;
9Moab [is] my washpot; over Edom will I cast out my shoe; over Philistia will I triumph.
10Who will bring me into the strong city? who will lead me into Edom?
11[Wilt] not [thou], O God, [who] hast cast us off? and wilt not thou, O God, go forth with our hosts?
12Give us help from trouble: for vain [is] the help of man.
13Through God we shall do valiantly: for he [it is that] shall tread down our enemies.

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Posted 4:10 p.m. Tuesday, Jan. 29, 2013
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I attended part of a January 20, 2006, "day workshop of interventions" — aka "a day of dialogic interventions" — at Columbia University on "Radical Politics and the Ethics of Life."[1] The event aimed "to stage a series of encounters . . . to bring to light . . . the political aporias [sic] erected by the praxis of urban guerrilla groups" in Europe and the United States from the 1960s to the 80s.[2] Hosted by Columbia's Anthropology Department, workshop speakers included veterans and leaders of the Weather Underground Bernardine Dohrn and Bill Ayers, historian Jeremy Varon, poststructuralist theorist Gayatri Chakravorty Spivak and a dozen others. The panel I sat through was just awful.[3]
Veterans of Weather (as well as some fans) seem to be on a drive to rehabilitate, cleanse, and perhaps revive it — not necessarily as a new organization, but rather as an ideological component of present and future movements. There have been signs of such a sanitization and romanticization for some time. A landmark in this rehabilitation is Bill Ayers, Fugitive Days: A Memoir (Beacon Press 2001; Penguin Books 2003). This is a dubious account, full of anachronisms, inaccuracies, unacknowledged borrowings from unnamed sources (such as the documentary, Atomic Cafe, 17-19), adding up to an attempt to cover over the fact that Ayers was there only for a part of the things he describes in a volume that nonetheless presents itself as a memoir. It's also faux literary and soft core ("warm and wet and welcoming"(68)), "ruby mouth"(38), "she felt warm and moist"(81)), full of archaic sexism, littered with boasts of Ayers's sexual achievements, utterly untouched by feminism. (Among Ayers's many errors are some that betray ignorance of the Women's Liberation Movement: he repeats the media-generated myth that 1968 Miss America protesters burned their bras (117).)
Ayers is the perfect Weatherman: "Hostility to feminism," writes Dan Berger in a new history of Weather, "characterized the organization from the beginning"[4] — and this at a time when radical feminism was growing. Weather kept its distance from one of the most vibrant movements of its time, taking such archaic positions as "The Women's Question is a Class Question," just a part of capitalism rather than patriarchy.[5]
There are too many inaccuracies in Fugitive Days to list here. Some are petty: Howdy Doody fans will wonder whether Ayers's "Uncle Bob" (24) is the same as "Buffalo Bob." But some of the errors reflect political blind spots. One such error concerns Marion Delgado, who was a kind of a Weather saint, but Ayers can't even keep his hagiography straight. A photo of Marion, a five- year-old Chicano boy, smiling and holding up a piece of concrete, appeared in the Students for a Democratic Society (SDS) weekly paper, New Left Notes, with a caption indicating that he had caused a train wreck with his concrete. Weatherpeople began, in hommage to this act, to sign and present themselves as "Marion Delgado." But Ayers (144) places this event in Italy — with all of Weather's third worldism, he can't tell the difference between Italians and Mexicans (or Californians) — and says that the train that Delgado derailed was a freight train, and that nobody was hurt. Inaccuracies aside, it's bizarre for a political group to admire this child's act. In a learned disquisition on Marion, Kirkpatrick Sale, SDS (New York 1973), 605n explains that Marion had derailed a passenger train in California in 1947. Ayers's changing a passenger train to a freight train, and his stress on the claim that there were thus no injuries, is one of many sanitizations in his book.
All in all, Ayers romanticizes and reaffirms Weather: "I regret nothing." In ways totally compatible with postmodernism, he boasts of faulty memory and subjectivity as the only truth. "Memory is a motherfucker," he begins; "I myself remember almost nothing" (7):
There is . . . a necessary incompleteness here, a covering over of facts and a blurring of details, which is in part an artifact of those fugitive days and those exquisite and terrible times . . . Is this, then, the truth? Not exactly. Although it feels entirely honest to me (preface).
Fugitive Days was published in September 2001. In a striking coincidence, an interview with Ayers (and Dohrn) appeared in the New York Times on September 11, 2001, under the stunning headline, "No Regrets for a Love of Explosives; In a Memoir of Sorts, a War Protester Talks of Life with the Weathermen." After 9/11, nobody wants to talk about this classic and deeply embarrassing article. "I don't regret setting bombs," Ayers begins; "I feel we didn't do enough." Here, too, he boasts of his tenuous connection to truth. In his response to the Times' quoting some of his above remarks about "truth," he says, "Obviously, the point is it's a reflection on memory . . . It's true as I remember it." Thus, the postmodernism in the contemporary air provides him with cover for the rehabilitation of Weather.
The 2002 film The Weather Underground was made by younger people and seems well intended.[6] But it offers the viewer a Hobson's Choice between Weather and Todd Gitlin: I didn't know whether to shit, or go blind! There is in actuality much space for an effective left between these two bizarre poles. Despite the substandard product that Weather veterans are peddling, a sympathetic response to a bowdlerized Weather may not be so hard to achieve in the present frustrated and disoriented mood of the left. Bernardine Dohrn says elsewhere: "I have not met with such intense curiosity from the young about our experience since I came overground at the end of the seventies. If we were to take an anti-imperialist show on the road, we would sell out."[7]
Many students and faculty have been infected by postmodernism in this, its terminal phase, and therefore have little concern for concrete reality. So Weather can be discussed in appealing-sounding abstractions, without reference to the destructive inanities of their role at the June 1969 Chicago convention of SDS, the October 1969 Days of Rage,[8] the bombings, the bombing fuck-ups, etc.
Weather's craziness was seen at the time: Maurice Isserman notes contemporary parodies of "You Don't Need a Weatherman to Know Which Way the Wind Blows": "You don't need a fisherman to know when something's fishy," and "You don't need a rectal thermometer to know who the assholes are" (H-Amstdy 1/30/06). And today, some former WUers have offered intelligent critiques. Mark Rudd sees WU as "a total disaster," and regrets having
chosen the stupid, losing strategy of 'revolutionary' violence . . . [T]he Weather Underground was a huge fuck-up! We did the work of the FBI by destroying SDS. We accidentally killed three of our own people. We split and undermined the larger anti-war movement.. the importance of the Weather Underground was that it was a total disaster. "Don't try this at home."[9]
Rudd's fellow Weatherperson Cathy Wilkerson's critical ZNet review calls Ayers "inaccurate," and sees the book as "a cynical, superficial romp . . . making these struggles seem like a glorious carnival."[10] Speaking of Ayers's descriptions of his relations with women, she notes his
absolute lack of reflection since then . . . Ayers relates his relentless sexual encounters without the slightest trace of awareness that some of these encounters might not have been so positive for the woman . . . He indicates no awareness that he might have used his privileges to provoke women to give him access to a vulnerability that he was unable to honor.
It is worth recalling that abuse of explosives was only one of many Weather errors. The chamber of horrors would have to include Dohrn's remark at the 1969 Flint Michigan SDS "War Council" concerning the murders committed by the Charles Manson gang in Los Angeles: "Dig it: first they killed those pigs, then they ate dinner in the same room with them, then they even shoved a fork into the victim's stomach. Wild!?"[11] This bring us to Weather's "white skin privilege" line.
While recognizing the role of racism in America, the white skin privilege analysis placed Weather in opposition to whites in general and to the white working class in particular, towards whom Weather was dismissive and contemptuous. It saw whites as complicit and corrupted beneficiaries of racism and imperialism who had sold out and were therefore to be opposed, perhaps killed, rather than addressed, educated, and recruited, with a program relevant to their situation. "Fight the People," said Ayers and early Weather.[12] Ayers recalls his thoughts concerning white skin privilege at the time of the climactic 1969 SDS convention (139). The Revolutionary Youth Movement (i.e., Weather), he says, saw racism as
providing privileges and material benefits . . . to white people, mystifying many and winning their allegiance . . . white skin privilege was . . . a real and effective bribe against consciousness and struggle . . . white people are mostly brainwashed. We lucky few will wake them up . . .
Other than the slight wryness of tone, there is no evidence that Ayers either had, or has, any criticism of the substance of this notion of administering a wake-up call to whites, rather than trying to convince them politically. (Recall that he says that he regrets nothing. One measure of the pervasiveness of this Piafian theme appears in the blurbs at the front of Ayers's book, praising him: "Writes . . . without . . . apology"; "no . . . remorse" [Thomas Frank]; ". . . without a trace of . . . 'second thinking' "[Edward Said].) This is a position that would lead to justification for killing whites — including their babies: "All white babies are pigs."[13] The oft-repeated claim that Weather killed nobody but themselves ignores the fact that the bombs being prepared when the townhouse blew up in 1970 were laden with roofing nails as shrapnel, and intended for detonation at a dance at Fort Dix. Only Weather incompetence saved these prospective victims from the grotesque deaths visited on three Weatherpeople.[14] (Today, those who didn't live through all this may nonetheless get the feel of Weather's positions by considering Ward Churchill's condemnation of the "technocratic corps" who died as victims in the 9/11 World Trade Center attack as "little Eichmanns."[15])
At the workshop at Columbia, Bernardine Dohrn served up all the hoary platitudes about the everyday violence of the standing order — all true — leading inevitably to a justification of violent response by a tiny minority substituting itself for a mass movement; at the same time, she offered a rhetorical parenthesis rejecting armed struggle. Neither the efficacy nor morality of Weather tactics and theories were scrutinized, nor any inquiry made into how you construct a majority radical democratic movement by denouncing and writing off the majority. Dohrn's defense of Weather included the remark that in the face of terrible oppressions and injustices, it is necessary "to do something about it, it almost doesn't matter what." But it does matter, if we are interested in building rather than tearing apart a new left. Clearly, almost forty years after the Weather disaster, she hasn't gotten it. Indeed, she says that the actions of WU "made people smile." (For one fan's confirmation of this contention, see Roz Payne (posting on H-Amstdy [1/30/06]): "We smiled when we read of their actions, which NEVER harmed people except themselves.")
Weather killed and buried SDS — a catastrophe for the left. (This is a complex matter, which I originally addressed here in too breezy and unqualified a manner. Clearly, it was not Weather alone that killed SDS. On the other hand, note Mark Rudd's view above that the Weather Underground destroyed SDS.) Dohrn passes lightly over this, saying that SDS wasn't worth saving by the time Weather came on the scene. An anarchist in the audience made the important point that how you make the revolution will affect the kind of revolution that you get. Partly agreeing, Dohrn insisted that, while underground, Weatherpeople not only practiced participatory democracy, but also got closer to the working class and to various minorities. Just picture it: Weather, while underground, super-closeted and of necessity concealing their politics, makes friends with the working class (whom they have already disdainfully written off) — "nobody here but us regular American folks." Former WUer David Gilbert's reminiscence comes closer to the reality: "When you're underground, you can't go around saying, 'I'm your local representative from the Weather Underground. Let's discuss politics.'"[16]
As I mentioned above, the discussion of the Weather Underground at the Columbia workshop lacked concrete specifics. If we look beyond the abstraction to those specifics, Weather is a tragic laughingstock. It's the postmodern mood that allows such weird and empty discussion. How wonderful: we have lived to see Weather's posthumous rehabilitation in pomo hands. But we need a new left today, and the evasion of realities of past, present and future won't help to build this left.
* * *
There was much to laugh about, and much to weep about in the event at Columbia. But the funniest moment came when Columbia anthropologist Beth Povinelli recalled that when she was invited to speak on urban guerrilla groups, her first thought was that her brother is a primatologist.
Is all this just beating a dead horse? Although I would hope so, in the present mood on the left there is some receptivity to a rehabilitation of Weather and Weather-like strategies, especially among the young who didn't live through the original reality. (One straw in the wind has been the confused and uncritical response to Ward Churchill in many parts of the left.) We have seen testimony from Dohrn and others about receptive audiences. As this is written, there is a promising attempt to found a new organization called SDS, and I wish it well. But for a sample of the uncritical, indeed adoring attitude towards Dohrn and her legacy by one of its main organizers, see Thomas Good, "From SDS to N[ational] C[onference on] O[rganized] R[esistance]: Socialism, Anarchism and Bernardine Dohrn." This is an enthusiastically positive report of a talk by Dohrn, which notes that "Her revolutionary passion [is] still intact after all these years of struggle" and describes her as pointing out "that one glaring failure of the Sixties was the ostracizing of [Vietnam] veterans" — not a word is said about the glaring failure of Weather. Good calls himself "an old admirer" and describes meeting Dohrn as "a very special moment for this New Leftist."
Another sign of the rising interest in Weather and the Weather legacy on the left is a flowering of literature, with varying degrees of admiration and criticism. In addition to Ayers, Fugitive Days, see, for instance, Ron Jacobs, The Way the Wind Blew: A History of the Weather Underground (Verso 1997; reissued 2005); Dan Berger, Outlaws of America: The Weather Underground and the Politics of Solidarity (AK Press 2006)[17]; David Gilbert, SDS/WUO: Students for a Democratic Society and the Weather Underground Organization (Abraham Guillen Press 2002); Dan Berger, Chesa Boudin, Kenyon Farrow, eds. (preface by Bernardine Dohrn), Letters from Young Activists: Today's Rebels Speak Out (Nation Books 2005). For a valuable scholarly contribution, see Jeremy Varon, Bringing the War Home: The Weather Underground, the Red Army Faction, and Revolutionary Violence in the Sixties and Seventies (University of California Press 2004). For FBI materials on Weather Underground, see here. Some former WUers have memoirs in progress which will give a very different picture from that offered by Ayers.
* * *
Just as this goes to press in May, there are two interesting developments relevant to the rehabilitation of the Weather Underground.
1) Weather Rehabilitation and the New SDS. Together with others, Thomas Good — mentioned above in connection with his admiring views of Bernardine Dohrn — organized the first Northeast Regional Conference of the refounded Students for a Democratic Society at Brown University, April 23, 2006. (The following account is based on material on the SDS website and postings on the SDS discussion list, "New Left Cafe.")
By a top-down process that led to some disagreement within SDS, Dorhn was invited as one of a small number of keynote speakers. (Ironically, Good is a self-described Wobbly and anarchosyndicalist.) Dohrn was billed as a "founding member of the Weather Underground." This is not a neutral self- identification. Allowing herself to be described this way, or perhaps asking that she be so presented, singles out a specific part of her background and suggests pride rather than understanding of her destructive role in those years. (As we will see, her speech offered not a word in response to criticisms of Weather.) Suppose I asked to have myself introduced at a speaking gig as "Jesse Lemisch, who joined the Communist Party in 1939 and rejoined in 1956." This would be kind of in-your-face, and would seem to oblige me to offer some explanation.
Pictures and a video of Dorhn appear on the SDS website, and she was treated with reverence at the conference. But there was an exception to this — a dispute that illuminates the new SDS and Weather, and raises questions about whether SDS is open to debate about its politics and willing to think critically about the legacy of Weather.
One of the keynote speakers was Bob Ross, an old SDSer and a founding member, now Professor of Sociology at Clark University and an activist in the anti-sweatshop movement. He made points critical of Weather, violence, and bombing. Dohrn, speaking next, addressed none of this. What is of particular interest to us is how others viewed Ross's raising the point, and Dohrn's silence. Paul Buhle, perhaps neutrally, reports that Dohrn "avoided the old controversies about Weather." But Thomas Good reports himself as "dismayed by the shots [Ross] took at Weather," and he brands those remarks as "sectarian" and possibly leading to "factional backbiting." He goes on to describe Dohrn as "eloquent as ever," a "class act [who] did not respond to Bob Ross's comments and focused on the future of the new SDS." Another speaker, named "m(A)tt," a "social anarchist" from the CLASH Collective of Hartford, tore into Ross, dismissing in the harshest terms Ross's criticism of Weather: Ross had made a "poor choice of a venue to grind his axe . . . Bernardine Dohrn, show[ed] her inherent female supremacy [wow, unpack that phrase!] by taking the high road and declining to use a captive audience to settle scores from thirty-seven years ago . . ."
Thomas Good says that the new SDS is approaching 100 chapters. The rebirth of such an organization is in many ways good news. But from the above it would seem clear that SDS isn't open to debate about the politics that Weather represented. I'll resist the urge to speak of those who condemn themselves to relive the past. But it is vital that SDS face up to this part of its past if it is to help in building the kind of daring, democratic radicalism that we need. A left organization that dismisses internal political debate as mere sectarian backbiting doesn't have a very bright future. Too bad.
(Meantime, at the conference as elsewhere, attention to Bernardine Dohrn once again generally violated the old rule, "Say anything you want about me; just spell my name right." Try it yourself.)
2) Imminent publication of Bill Ayers, Bernardine Dohrn, Jeff Jones, eds., Sing a Battle Song: The Revolutionary Poetry, Statements and Communiques of the Weather Underground 1970- 1974 (Seven Stories Press, scheduled for June 1, 2006). Thanks to David Barber for calling this to my attention. I have only an "early version" of the manuscript, which may not be complete. There is neither time nor space here to give it its due, and I have only been able to give it quick scrutiny. The material in this volume, consisting of documents from the time, is of historical value and will help readers part way to a better understanding of Weather.
This book consists of three components, all originally published in 1974 and 1975, put together in one volume now in order to catch and extend the wave of Weather rehabilitation. Jonah Raskin's 1974 introduction to Weather's Communiques (many of which were signed by Dorhn) offers a useful short history of the organization from a partisan although not uncritical perspective, and presents a chronology. Raskin justifies Weather's bombings. The communiques themselves are meaty and certainly remind us of the times. People should read them to know just what it is that they are romanticizing. But Weather must be understood both for what it said and for what it did, and this volume is not adequate for those seeking fully to understand the horrors that they carried out and the damage they did to the left.
The volume's poems by Weather Underground women are an attempt to shore up Weather's reputation in an area where Weather itself has acknowledged great weakness — the organization's alienation from the Women's Liberation Movement. But it's hard to see how these poems will help Weather's reputation for feminism. This section includes poems celebrating a bombing at MIT, the Symbionese Liberation Army (this poem appears twice in the book), and the hijacking of a Pan Am jet; another condemns American POW's in Vietnam, and an especially peculiar one celebrates "Our Men" as "sinewy warriors" with "long hair curling and straggling down your backs . . . " This is feminism?
This is a revised and expanded version of an article originally posted on History News Network, 1/23/06; H-1960s 1/23/06; Portside 1/27/06; ZNet 1/28/06; H-Amstdy 1/31/06. I have benefited from the discussions that followed these postings.
1. See the announcement and program.
2. The "Postmodern Therapies" listserv's "Postmodern Terms from A to D" offers a definition of "aporia": "Wonder and amazement before the confusing puzzles and paradoxes of our lives and of the universe. Socrates and the other ancient philosophers tried to evoke the philosophic spirit in young men by awakening their aporia, not by simply providing answers to these puzzles." Does that clear it up?
3. I assume that inclusion as a speaker in the conference did not necessarily imply approval of the Weather Underground (WU), nor of Weather — although I know of at least two former WUers who have taken critical positions on Weather, and who decided that it was fruitless to attempt to attend as critical voices and so did not participate. I have commented only on the session I attended, where the speakers were Bernardine Dohrn and Columbia Anthropology Professor Elizabeth Povinelli.
4. Dan Berger, Outlaws of America: The Weather Underground and the Politics of Solidarity (AK Press 2006), 292.
5. Berger, Outlaws of America, 219.
6. For my critique of an earlier film that touches on Weather but fails to explain the collapse of SDS, "Rebels with a Cause" (2000), see Lemisch, "Students for a Democratic Society, Heroically Portrayed, Before the Inexplicable Fall: Consensus History in a Left Film," Film & History, 31.1 (Spring 2001).
7. Bernardine Dohrn, "Letter to Young Activists: Beware Sixties Nostalgia," MRZine, July 7, 2005. This is adapted from Dohrn's preface to Dan Berger, Chesa Boudin, Kenyon Farrow, eds., Letters from Young Activists: Today's Rebels Speak Out (2005). See also Newsreel co-founder Roz Payne (H-1960s 1/25/06): "My students were taken by the . . . Weather Underground film. Most of them thought the people were brave and understood why they did what they did because they did not kill anyone (except for themselves in the town house)."
8. At the time, Weather's adversary, Progressive Labor, characterized the Days of Rage as the work of "hate-the-people lunatics." Nigel Young, An Infantile Disorder? The Crisis and Decline of the New Left (London 1977), p. 276.
9. Mark Rudd, "How a Movie Changed My Life," "Heartland Journal," Summer 2005.
10. See here.
11. Sale, SDS, p. 628. Dan Berger's generosity to Dohrn, who is one of his major sources, appears here in his failure to offer more than a brief paraphrase of Dohrn's awful words, while giving equal space for her defense: Outlaws of America, 123. Dohrn's words are just the tip of the iceberg: the fork motif was widespread in Weather, in greetings, farewells, names of groups, etc.
12. Berger, Outlaws of America, 96. Always apologetic, Berger says: "[Fight the People] was, to be sure, part of the group's early hyperbole, but a closer reading reveals it to be a more complex view of confronting white supremacy."
13. Sale, SDS, 628: "The Weatheranalysis held that whites were virtually useless in the world-wide confrontation going on, and except for a few brave streetfighters like the Weathermen, they were all corrupted, bought-off tyrants. Logically, then, the death of a white baby is a positive revolutionary action, and indeed the Weathermen actually held abstract debates at the [1969 Flint] "war council" about whether killing white babies is 'correct', a Weatherman at one point shouting out to the audience, 'All white babies are pigs.' From there it was only a step to Dohrn's ecstatic speech about the Charles Manson gang . . . "
14. I have seen no mention of the significance of the fact that the bombs would also have killed female dancing partners. WU could not have failed to foresee this, so there would have had to have been some extremely obnoxious theoretical rationale, e.g. "class enemies," "soldiers' girlfriends," or "collateral damage."
15. "If there was a better, more effective, or in fact any other way of visiting some penalty befitting their participation upon the little Eichmanns inhabiting the sterile sanctuary of the twin towers, I'd really be interested in hearing about it." See Anthony Lappé, "Ward Churchill's Banality of Evil" and "Ward Churchill Statement." For Churchill's fuller justification of the WTC attack and his support of "the gallant sacrifices of the combat teams," see his "Some People Push Back: On the Justice of Roosting Chickens." There may be more direct connections between Churchill and Weather. A Google search finds claims that he was an active participant in the 1969 Days of Rage, plus a boast, later rescinded, that he taught bomb-making to WU.
16. Berger, Outlaws of America, 153.
17. This is a serious and voluminous work, based on research in written sources and interviews ("the backbone of the book"(x)) with more than twenty former WUers. Outlaws of America is a useful compendium by a hard-working young scholar. But it is a deeply apologetic work. It is unintentionally an almost laughable record of endless "error," "failure" and "unraveling." Each such failure is explained away: see for instance, the above defense of the white skin privilege line; or, "The townhouse blast was a grievous error, but Weather's broader analysis of the political context still held true" (131). Berger holds back uncomfortable data, such as Dohrn's Charles Manson speech. Again and again, Berger's interviewees express second thoughts, but he presents such thoughts only ad hoc, rarely finding fundamental flaws in WU. Berger's effort at rehabilitation prevents him from acknowledging that, even within the limits of his partisan argument, Weather's legacy might be presented as at best a dual one. I hope for better work from this energetic young scholar.


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- Press Release
The Case for Discretion and Proportionality in Our Immigration System
Washington D.C. - It has long been the case that those responsible for carrying out and enforcing our nation's laws do so with a measure of discretion and proportionality. Every day, law enforcement officials and judges exercise discretion in charging and sentencing decisions, weighing differing priorities and social values, and matching punishments with crimes. Consequently, minors are treated differently in the criminal system, and traffic violators and murderers receive different punishments. The use of judgment and proportionality is so ingrained in our legal system—with the exception of immigration law—that we take it for granted. Today, the need for discretion and proportionality is needed more than ever in our antiquated and over-burdened immigration system to ensure that the government spends its limited resources on high priority cases, and that immigrants who have a strong case for remaining in the U.S. are able to do so if current law provides for an avenue of relief.
To that end, a wide range of organizations, including the American Immigration Council, have been asking the Obama Administration to use its executive authority to exercise discretion in the immigration context. In June, Director John Morton of Immigration and Customs Enforcement (ICE) issued a memo outlining new guidance on the use of prosecutorial discretion in a wide range of circumstances. The memo signals a greater commitment to using limited resources to enforce immigration law with an understanding of the need for measured action and fairness in the immigration context.
Unfortunately, House Judiciary Committee Chairman Lamar Smith has decided that the long accepted ideals of discretion and proportionality should not apply to immigration. Smith has introduced the "Hinder the Administration's Legal Immigration Temptation Act" (HALT) of 2011, which attempts to invalidate the long tradition and legal authority of the executive branch to use its discretion and other powers to improve and implement laws. Apparently Smith believes a different administration will be worthy of such discretion because the bill would sunset on January 21, 2013—the day after the next inauguration. The HALT Act goes beyond limiting prosecutorial discretion and seeks to suspend long respected forms of immigration relief including Temporary Protected Status (TPS) (which was granted to Haitians after the recent devastating earthquakes) and family unity waivers (such as those that allow U.S. citizen military members to reunite with their undocumented spouses).
What's most disappointing is that Chairman Smith has advocated for the use of prosecutorial discretion in the past. The New York Times recently noted:
Back in 1999, Mr. Smith was one of several members of Congress who wrote the attorney general and the head of the Immigration and Naturalization Service, arguing that 'unfair' deportations had caused 'unjustifiable hardship' for otherwise law-abiding immigrants who had jobs and families and close citizen relatives. 'True hardship cases call for the exercise of discretion,' the letter said.
Why the change in heart? Only Mr. Smith can answer that. However, as it becomes increasingly clear that large numbers of people are no longer migrating to the U.S., our focus must turn to those who are living, working, and raising families in America. The Administration's understanding that immigration agencies need to prioritize enforcement activities and exercise discretion when considering deportation should be encouraged by Congress and the public.
For more information contact Wendy Sefsaf at [email protected] or 202-507-7524.


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For a while, hedge fund managers were the guys taking the blame for the financial crisis as banks plummeted amid short-selling. Once their bets turned out to be astute, we turned our attention to the bankers who broke their own institutions.
But the spivs of Mayfair have not been forgotten in Brussels and the future of the hedge fund industry – at least in Europe – is at the mercy of European Union horse trading as politicians consider the directive on alternative investment fund managers.
Battle of Brussels
Those debates in Europe will continue. The original European Commission proposal unveiled in April was attacked in some countries as being too timid and by many in the industry's European base in London as excessively restrictive.
Parliamentarians and the current EU presidency want to tighten up rules on traders' income, seeking restrictions similar to those being brought in on bankers' bonuses and put an end to short-selling where fund managers bet on a stock going down.
Ranged against them are the European Central Bank and the British Government, which warn that further restrictions could tilt the playing field against EU companies.
Hedge fund managers, for their part, are threatening to move their operations to offshore havens, arguing that their pay is no business of regulators.
Greater Transparency
Uncertainty in the sector actually means that it may be a good time for pension schemes to look afresh at the alternatives space. This regulatory chaos is seen as a driver behind rising numbers of new onshore funds being launched by hedge fund managers using the more limited powers available under an EU directive known as 'UCITS III', which governs investment funds sold across Europe.
Managers of both hedge funds and absolute return funds can use techniques such as shorting (betting against the direction of a stock or index). However, the onshore UCITS III-compliant funds face more restrictions on these types of strategies.
As far as pension funds are concerned, the key advantages of UCITS III-compliant hedge funds over 'full' hedge funds are their transparency and liquidity. During the financial crisis, many investors struggled to remove money out of ailing funds. Many traditional hedge funds operated with a 30-day notice period for redemption and other restrictions.
UCITS III funds must have daily or weekly dealing – meaning, you can get your money out quickly if a fund is not performing as well as you expected.
Transparency can also be issue. Robert Howie, principal at consultancy Mercer says: "Hedge funds are often domiciled somewhere like the Cayman Islands, where there is regulation but not to the extent that there is in Europe". Onshore UCITS III funds are regulated like mainstream investment funds.
A New Trend?
Half of all European hedge funds are either planning to launch a UCITS III fund, dubbed 'Newcits' in some quarters or have already done so, according to a recent hedge fund data provider survey of 650 managers. Just over 20% have already launched a fund. A further 30% are looking at a launch. Big names such as Marshall Wace, Exane and Man Investments are already in the sector.
Among those about to enter is Hugh Hendry of Eclectica. His newly-launched Eclectica Absolute Macro Fund will be a mirror of Hendry's renowned global macro hedge fund and will seek to provide an annualised 10% return over cash on a rolling three-year basis.
As an example of the breadth that such managers can cover, Hendry's fund will invest in long and short global equities, global fixed income, commodities and currencies.
Hendry told Pensions Insight that the move was to get access to clients who are restricted, perhaps by the minimum investment level of £100,000, from investing in his flagship Eclectica hedge fund, which launched in 2002. In its worst year, Hendry's hedge fund lost 3%. Its best was a gain of more than 50%.
The conventional fund management sector has also ventured into UCITS III. Big names such as BlackRock, Schroders and BNY Mellon all offer absolute return versions of some of their mandates to investors.
Robert Howie, principal at consultancy Mercer, says that looking outside conventional long-only mandates can help pension schemes access managers' full range of skills.
Risk and Reward
But there is a price to pay for looking at the sector. For UCITS III funds, a 2% annual fee plus 20% of outperformance of a standard such as London Interbank Offered Rates (LIBOR) is common. Howie says: "The charges may be worth paying to the successful manager. But just because you run a fund does not mean you are successful".
Hendry is highly critical of fund houses' charges for UCITS III mandates: "I think it is absolutely outrageous that anyone launches a UCITS III fund with a performance fee. By all means, after three years, if you have been a tremendous success and have a lot of money coming into your portfolio, maybe to ration the demand, I think you have the legitimacy to introduce a performance fee".
The freedom managers have with UCITS III funds can also mean they are unpredictable. Howie says: "These funds allow managers great freedom in terms of using derivatives, in using leverage and using shorting. These are all good to have, but if the manager is unsuccessful or there is operational failing, employing the ideas badly, they may lose money".
Some hedge fund managers argue that going to UCITS III is a 'step back' to a more simple approach while long-only managers are learning new skills. Howie notes the risk: "You may have a manager that is successful in the long-only world but cannot short stocks [successfully]".
Eclectica's Hendry, however, is deeply dismissive of previously long-only houses venturing into the UCITS III area. "The launching of UCITS III funds is just a greed trade. This is just another product being issued by the long-only investment community as a means of raising money," he says.
"They tried focus funds, they tried concentrated funds, they tried 120/20 funds. Everything has failed and I am not hugely impressed by the notion of long-only managers launching UCITS III hedge funds. It is like a farmer going into the manufacturing sector. It is not their business".
Hendry argues that they have neither the expertise nor the access to some deals that hedge fund managers have. At the same time, you have to ask if by using a hedge fund manager's UCITS III fund, you are actually getting the full benefit of his skills.
Some try as best they can to replicate the hedge fund strategy, often by using derivatives based on a special index. Others focus on using their expertise, for instance, in identifying market trends without trying to copy the approach. Some have the same teams running each type of fund, others separate.
Asked if his UCITS III fund was a watered down version of the hedge fund, Hendry acknowledges "very much so". He notes that there are certain techniques he uses on his hedge fund that he cannot use on the UCITS III fund, such as trading in default swap spreads on sovereign debt. Some methods of betting on interest rate expectations are also close to him.
It is evident that the lines are blurring between long-only fund managers at one extreme and racy hedge funds at the other. But until the UCITS III market has proven that it can offer something that is not merely an unsatisfactory compromise between the two, pension schemes are wise to keep an eye on the sector but to tread carefully.
This article first appeared in the January 2010 issue of Pensions Insight. For more information, please go to www.pensions-insight.co.uk.
This article first appeared in FTSE Global Markets (Pg 24, Issue 39, January/February 2010). For more information, please visit www.ftse.com.


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I went fishing this morning. After a short time, I ran out of worms. Then, from the corner of my eye, I saw a cottonmouth snake, with a frog in his mouth. "Frogs are good bass bait," I thought to myself.
Knowing the snake couldn't bite me with the frog in his mouth, I grabbed him right behind the head, removed the frog and put it in my bait bucket. Then I realized I had a problem: how was I going to release the snake without getting biten?
Desperate, I grabbed my bottle of Jack Daniels whiskey and poured a little in the mouth of the snake. Its eyes rolled back. It went limp. I released the cottonmouth into the lake, without incident, and carried on fishing using the frog.
A little later, I felt a nudge at my foot. There was that same snake, with another frog in his mouth.
JR Hafer writes from his home in central Florida.
Click above to tell a friend about this article.


text: Diving with a dry suit makes that underwater experience even more intense. By keeping dry under the water and on the surface, you are warmer and more comfortable from start to finish-and that enhances the dive tremendously. Dry suit diving is the norm for advanced and technical divers, whether for cold water or for multiple dives in temperate waters. And no matter what the diver's level, a dry suit is imperative for all real cold water diving. Dry suit diving lets you dive all year-round, anywhere on the globe, in total comfort and safety. Dry suit divers are not only seen in frozen lakes or in northern seas, they are also common in the Red Sea and the Mediterranean: even in warm water, conducting 3 or 4 dives a day, the body feels the difference. Dry suit diving is synonymous with protection. Thermal protection is the priority feature but a dry suit also shields a diver from polluted waters, sharp edges in wrecks or coral-cuts. Dry suits come in two main styles: membrane and neoprene.


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I've made a commitment to master a career in urban real estate. Being an expert in my field is important to me – that's why I've taken the time to build www.bellevuetowercondos.com. It is important to me to share as much information about the condo market as I can. This site was developed with you in mind. Â You can quickly access listings for sale, rent or even sales records for the building.
For those of you looking for advice on buying, selling, or renting a piece of real estate in Seattle, please contact me to discuss further. Â You may also click any of the pictures below to learn more. For those of you that we have worked with before, thank you for your support. Â For those of you looking to work with us for the first time, we look forward to getting started and feel that you will experience great results from years of hard work and the passion we have for Seattle real estate.
I welcome your questions, concerns and anything else you need assistance with.
Jeff J Reynolds
Principal and Founder
Want to see some of the homes I've sold?


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Software Patents in Europe
[Introduction | Background | Status | Further Reading ]Software patents are bad for your health
3 January 2005
Dear Mr LEE Jong-wook,
Software patents grant a monopoly on their specific idea. The patentee can grant or withhold authorisation to use that idea and unilaterally define the terms under which such authorisation is granted or withheld. This is before even a single line of source code has been written. In fact: lawyers are generally in a better position to obtain software patents than the majority of programmers are. Each program consists of thousands of ideas -- each of them potentially subject to patent claims. Even though the European Patent Convention explicitly excludes software from being patented, so far 30,000 software patents have in fact already been granted in recent years.
The discussion about a formal introduction of software patents has been ongoing for several years and we would like to make you aware of the effect of software patents on telemedicine, an area of great hope for many.
Today, we are seeing the first steps in the telemedicine area. Instead of being delivered by traditional post, X-Ray scans are transferred electronically, reducing the availability timescale from days to seconds. Physicians will soon be able to monitor individual patients remotely, something that will in particular offer possibilities of increased medical coverage for people in remote areas all over the world. Given the demographic development in northern countries and the increasing medical needs of potentially wealthy elderly people; that particular idea was patented years ago.
The database of the European Patent Office currently contains 69 patents directly referring to "telemedicine". That seemingly low number should not let you rest easy. Not only is the number of software patents likely to skyrocket after the formal introduction of software patents.
Each application in the field of telemedicine will also depend on basic software principles to function. These basic principals include security, networking and data storage. Security in particular is key, because the number of methods to make computer systems secure are limited. There is no compulsory licensing of software patents, so market tactics are likely to see many applications disappear in courtroom battles before they have become available to patients. In addition, besides having to refinance the legal costs, each telemedicine and remote surgery application is likely to suffer from known security holes and stability problems.
Software patents are putting the wealth of the software patent lobby over the health of citizens in Europe and around the world.
That is why we believe software patents will adversely affect your cause and are asking you to take a firm stand against software patents. If you have further questions, need additional information or would like to help us prevent software patents in Europe, please do not hesitate to get in touch.
With kind regards,
Georg Greve
Free Software Foundation Europe (FSFE)


text: DieRotenSeiten London Colney: In London Colney, you will find a manifoldly red-light scene. DieRotenSeiten London Colney offer you a quick overview! Here you will find a whorehouse, a sex club, a nightclub, a bordello, a table-dance bar, a prostitute, a hooker, a cabaret, a brothel, a sex cinema or a gay in London Colney. Use DieRotenSeiten London Colney to find professional sex partners. Narrow your choice by choosing from prostitutes, sex clubs, escort agencies, sex cinemas, sex shops, erotic magazines and sex fairs in London Colney:


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Last Thursday and Friday I was in Beaufort, N.C, as part of a panel of judges for the Veneer Tech Craftsman's Challenge. The folks from Veneer Tech were gracious hosts, and the results of the contest will be announced in August at the International Woodworking Fair in Atlanta. After the winners are revealed I will be writing about some of them; we viewed an interesting array of furniture, cabinets and other veneered work. Before the judging began, we toured the facilities of Atlantic Veneer and Veneer Tech. In the next few weeks I'll be sharing photos of the process of manufacturing veneer.
Atlantic Veneer is a slicing operation. Logs of maple, cherry and white oak that were harvested in Pennsylvania and New York are unloaded in a yard the size of several football fields. The logs are kept under a spray of water to keep them from drying out before they are debarked and sliced lengthwise. Then the log halves are soaked in vats to saturate them and moved to the slicing machines.
The machines take slices of about half a millimeter thick off the logs , that's about 50 slices per inch of thickness. Veneers from individual logs stay together and in order throughout the process of drying, trimming and grading. This ensures that veneers can be matched for grain and color. One of the main uses for veneer of this quality is in architectural paneling where this kind of matching distinguishes high-quality work.
A few miles up the road from Atlantic Veneer is the Veneer Tech facility. Veneer Tech takes the individual leaves of veneer and splices them together into faces suitable for applying to cores for making hardwood plywood, or for sale as backed veneers. The plant has the capability of processing about 6 million square feet of veneer a month, all of it carefully graded and sorted to maximize appearance and yield. The stack in the photo above is approximately 20,000 square feet of sapele waiting for a final trim before being spliced into sheets.
This is a small portion of the finished product; each stack is a different grade or species of material ready to be processed in house for backed veneer sheets, or shipped to a customer who will apply the faces to cores of plywood, particle board or MDF. In future posts, I'll be going into more detail about the stages between logs and finished faces.
Here are some supplies and tools we find essential in our everyday work around the shop. We may receive a commission from sales referred by our links; however, we have carefully selected these products for their usefulness and quality.


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Treasures of the Digital Archives: Alhambra Cabins – Soap Lake
Alhambra Cabins—Soap Lake, Washington, Conservation Department, Planning and Development Division, Lantern Slide Shows, 1910-1939, Washington State Archives, Digital Archives. Original item held at Washington State Archives, Olympia, WA.
This charming image of tourist cabins at Soap Lake is one of a series of 265 hand-colored glass lantern slides taken between 1920 and 1930 to promote tourism in Washington. Images show the construction of the Grand Coulee Dam, the Columbia Basin Project, the benefits of irrigation and water projects to Washington State, building projects, hotels, garages, dams, fishing and recreational activities, transportation facilities, shipwrecks, and scenic views of forests and rivers. A set of postcards from these slides is available from the Office of the Secretary of State.
Explore the Conservation Department, Planning and Development Division, Lantern Slide Shows Collection.


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This article describes the redesign implemented by the Cleveland Clinic Foundation (CCF) in response to changes in the healthcare marketplace. In this CCF redesign process, we redefined RN roles and added two new roles: patient care technician and patient care service associate. Strategies used to facilitate this process on two acute care units are described; outcomes of this process are presented.
Key Words: Academic Medical Centers, Hospital Units, Ohio, Work Redesign, RN Mix, Outcomes, (Healthcare)/Evaluation
The Advisory Board Company, a Washington, DC, based research group which focuses upon human resource management, healthcare, and banking, has described the growing interest of Wall Street in the health care industry (The Advisory Board Company, 1996). This interest results from the emerging presence of investor-owned healthcare entities. Wall Street presence in other industries has quickly transformed small "Mom and Pop" companies into meganational companies focused on revenue growth, growth in annual earnings per share, growth in profit margins, and healthy shareholder returns. Wall Street's coming interest in healthcare has brought these new and rigorous standards of performance to the healthcare industry, demanding simultaneously higher quality of care and lower costs. Such standards from the "for profit" sector influence those of us in the "not for profit" sector. However, success in delivery of healthcare services can come only through focused attention to meeting and exceeding customer requirements and seamless delivery of compassionate and concerned care at a competitive cost.
Two for-profit hospital systems have recently come upon the scene in the Cleveland area and now all Cleveland hospitals are experiencing increased competition. We are witnessing consolidation of hospitals into integrated delivery systems, hospital closings, staff layoffs, and care being provided in new ways and in new settings. The scene has changed dramatically. The purpose of this paper is to describe the Cleveland Clinic Foundation's (CCF) response to these changes, namely, a redesign initiative.
The Cleveland Clinic Foundation Experience: An Overview
At CCF we agree with the many experts who state that redesign efforts are essential to succeed in a world that now demands healthcare be delivered faster, cheaper, better, closer, and in a way that is more friendly than its competition. Downsizing is defined as a reduction in personnel to do the same work with fewer people (Hammer & Champy, 1994). At CCF we elected to "redesign" the work processes rather than downsize; we define redesign as the reorganization of tasks and personnel performing the tasks.
Our philosophy of redesign and the method used to accomplish it is consistent with Hammer's (1996, p. 14) belief that redesign requires a fundamental rethinking and radical redesign of an entire enterprise, i.e., its business processes, job definitions, organizational structures, management and measurement systems, and values and beliefs. The purpose of redesign is the achievement of dramatic improvements in critical measures of performance. These improvements include cost, quality, capital, and speed of service delivery. With this perspective on redesign also comes the understanding that, although we are a caring profession, a more focused business approach will be required in this new environment of tumultuous change, intense competition, and demanding customers.
The Redesign Endeavor
We followed the management engineering principle of asking the people who do the work to help redesign the work (Hammer and Champy, 1994). We asked the nursing staff, i.e., the doers, not the managers, on two units (orthopedic and cardiac surgery units) for their ideas on how to improve their work. The process began by an analysis of the work currently being done. Here we asked three specific questions:
- What is the outcome of this task/job, and is this outcome still viable in the present environment?
- How is the task currently being performed? Can it be done more simply or more efficiently?
- Who is currently performing the task? Is the task being performed by a person at an appropriate skill level?
Staff involved in the process brain-stormed while discussing all the individual jobs/tasks that they performed on a regular basis on the patient care units. This list of tasks covered a 12' X 12' wall and provided the framework from which we developed the subsequent steps.
Staff involved in the process brain-stormed while discussing all the individual jobs/tasks that they performed on a regular basis on the patient care units. This list of tasks covered a 12' X 12' wall ... |
The tasks that could be performed by unlicensed personnel were then sorted into clinical and non-clinical categories. This procedure led to creation of the patient care technician role (a clinical role) and the patient care service associate role (a guest services role). The patient care technician role includes specified nursing tasks that can be delegated by an RN to the technician, such as setting up of equipment, assisting patients with their activities of daily living , taking vital signs, and serving as another set of eyes for the nurses by noting changes in patient status. The patient care service associate is a multi-skilled worker who assists with, among other activities, transporting and discharging of patients, cleaning of patient rooms, and restocking of supplies.
The decision to move forward with the redesign effort was reinforced by our site visit to an academic institution already utilizing personnel in these two new roles. While making this site visit, staff were able to observe the redefined RN role, the patient care technician role and the patient care services role in action. These observations assured us of the value and practicality of the redesign plan. We saw first hand how teams comprised of an RN, a multi-skilled worker, and a service associate, functioned together.
Planning the redesign was a valuable experience for all staff. The task delineation and assignments step of the redesign endeavor was enlightening to the RNs since it revealed that much of their time previously had been consumed by activities in which they did not maximize either their professional education or their professional licensure. Task delineation and assignment of tasks also gave the staff nurses ownership in this redesign effort since these nurses ultimately determined what tasks were appropriately delegated to each level of service personnel.
The RN's role was redefined to be that of a care manager who directed the processes of care for the patient during the acute care episode and beyond. The RNs moved from focusing considerable time on activities not utilizing their professional skills to functioning at their upper limit of professional education and licensure. This move resulted in better use of nurses' professional skills and abilities. This role change provided the opportunity for RNs to look beyond the acute care episode to the full continuum of care. Today there is a better understanding of the patient's needs after discharge; the role redefinition outlined here allows the RNs to use their judgment to effect better patient care post-discharge.
Many employees who subsequently went through the Patient Care Technician Program commented about how much better prepared they felt to care for patients after completing the program. |
In addition, nursing unit assistants became excited about the redesign because they saw growth potential for their own job functioning. Many employees who subsequently went through the Patient Care Technician Program commented about how much better prepared they felt to care for patients after completing the program. The patient care service associate became an integral part of the unit team, rather than operating from an outside department, such as Housekeeping. Perhaps, however, the most important outcome of this endeavor was that it started a team building process that is continuing today.
A substantial amount of education and training was required to assure that these roles were performed according to established standards. Registered Nurses were taught the strategies of managed care, case management, delegation of tasks, supervision, and interviewing skills. Patient care technicians received clinical and didactic classes covering a variety of the skills to be used in their new role. For example, they were taught how to take vital signs and how to promote the patient's activities of daily living. The patient care service associates received training from other departments, such as Environmental Services, teaching them correct procedures for cleaning the patient care environment. Working together, these newly created teams have been able to meet the majority of the patient's needs.
As a result of the redesign, the skill mix on the units decreased in the proportion of RNs to non-licensed personnel. Specifically, the skill mix went from 80:20 (RNs to nursing assistants) to 60:40 (RNs to patient care technicians/service associates). This mix allowed for an increase in the number of available nursing personnel (although a proportionally greater number of the personnel had lower education and were non-licensed) while keeping the budget neutral.
Evaluation: Findings from Previous Studies
Healthcare literature presents an equivocal picture of the impact of RN staffing on quality of care. Some literature reviews suggest that higher ratios of RNs to other personnel have been shown to lower hospital mortality (Hartz et al., 1989; Knaus, Draper, Wagner, & Zimmerman, 1986; Krakauer et al., 1992; Scott, Forrest, & Brown, 1976.) The Institute of Medicine (IOM) (Wunderlich, Sloan & Davis, 1996), conducted an independent objective study requested by the Secretary of the Department of Health and Human Services, to explore the relationship of quality of care and patient outcomes to nurse staffing levels. In reviewing literature to determine if empirical evidence exists linking RN number and skill mix with quality, they found little evidence of this connection. The IOM commented that a serious paucity of recent research on the definitive effects of structure (such as specific staffing ratios) exists. This IOM study noted that the causal relationship between specific staffing ratios and quality of patient care in terms of patient outcomes while controlling for all other potentially confounding variables is not established (Wunderlich, Sloan & Davis, 1996, p. 121).
A major goal of this redesign effort was enhancing or maintaining quality of care while simultaneously keeping cost the same or reducing cost. Due to the anecdotal reports in the nursing and lay literature concerning the impact of RN staff reductions on quality outcomes, an evaluation goal was to systematically collect data relevant to patient quality outcomes.
A complicating factor in measuring changes in quality of care is the multiple factors that impact the care outcomes (Prescott, 1993). In complex organizations it is often impossible to isolate the determining role of any single factor upon the quality of care.
Due to the anecdotal reports in the nursing and lay literature concerning the impact of RN staff reductions on quality outcomes, an evaluation goal was to systematically collect data relevant to patient quality outcomes. |
Evaluation: The CCF Evaluation Plan
Here at CCF four specific units were studied to determine the impact of the redesign process on cost and quality of care. Two units, an orthopedic and a cardiac surgery unit, served as experimental units and underwent the redesign process described above, while two other units served as controls for these units: a gynecology and a medical cardiology unit respectively. These four units were matched for acuity, census, and staffing ratios. Clinical outcomes, specifically patient status outcomes, patient satisfaction, and physician satisfaction measures were obtained before implementing the redesign process and again six months following implementation on all four units. Additionally personnel satisfaction was measured both before and after implementation. Comparisons were made of the pre and post implementation scores for all four units; additionally each experimental unit was compared with its respective control unit after implementation of the redesign.
Evaluation of Redesign: Clinical Outcomes
Patient status outcome measures selected for the redesign evaluation included: a) safety issues, specifically, falls, pressure ulcer incidence, and medication errors; b) 30 day readmission rates along with incidence of adverse events, morbidity and mortality rates; c) patient satisfaction; and d) physician perception of quality of care. These outcomes were selected because of the theoretical expectation that redesign (staff mix change and new non-license roles) would impact these measures. Additionally the Cleveland Clinic Foundation and the Nursing Quality Management System supported their monitoring.
Our findings show that quality scores have improved for falls and medication errors. That is, the rate of falls per 100 patient days, and the rate of medication errors per 100 patient days, decreased after implementation of the redesign project. Pressure ulcer rates remained essentially the same, i.e., they continued to consist of sporadic occurrences, as was experienced during the pre-implementation period. This finding is partly attributed to the patient populations, i.e., frail, elderly orthopedic patients and acute cardiac surgical patients. Thirty day readmission, adverse effects, morbidity and mortality rates were too low on all units both pre and post redesign implementation to assess statistical differences.
The patient satisfaction measure, a self-developed tool, was administered within the 24 hour period before discharge. It assessed the level of satisfaction with different aspects of the hospitalization and included: nursing skills, time and availability of personnel, communication, and patient and family inclusion in teaching, as well as room cleanliness and availability of necessary equipment. Scores on this measure were high both pre and post implementation indicating patients were "usually" satisfied with care. There were no significant differences, using the t-test with an alpha level of .05, between pre and post implementation scores, nor between experimental and control unit scores post redesign implementation.
The physician satisfaction measure, developed in-house, assessed the same areas as did the patient satisfaction measure described above. Scores on this measure were midrange both pre and post implementation. Again there were no significant differences, using the t-test with an alpha level of .05, between pre and post implementation scores, nor between experimental and control unit scores post redesign implementation.
Evaluation of Redesign: Job Satisfaction and Security
Another important measure of outcome of the redesign process involves the extent to which staff are satisfied with the endeavor and the extent to which they feel secure in their jobs. We used the job satisfaction survey developed by Hackman & Oldman (1974) to measure the impact of redesign on employee job satisfaction. This survey assessed a) specific job dimensions, including activities such as skill variety, task significance, autonomy and dealing with others; b) experience of psychological states including meaningfulness and responsibility of work and knowledge of results; and c) responses to the job, including general satisfaction, motivation, growth and supervisory satisfaction. The post-implementation scores varied by unit and by category of worker, i.e., on each unit for each category of worker and for each area assessed, some scores remained the same, some showed more satisfaction with the job and some showed less satisfaction with the job. Although the experimental units had higher satisfaction scores after the redesign, using the t-test with an alpha level of .05, these differences were not significant. The data did suggest that the process of creating new work partnerships requires attention to the application of various team-building strategies, creation of trust, effective two-way communication and active management.
As might be expected, the RN staff worried about job security after the redesign was implemented. In reality, no RN on either of the redesigned units lost his or her job. Rather, budgeted unfilled positions were used to create the positions for the patient care technician and patient care service associate. The Cleveland Clinic Foundation is being transformed into an integrated healthcare system with a variety of points of care delivery. The Nursing redesign efforts are one example of this transformation. Within the CCF system, numerous opportunities for nurses have emerged. Here at CCF, as well as throughout healthcare, RN job security may be challenged but RN career security is heightened. Career opportunities for RNs continue in ambulatory, rehabilitation, home care, and subacute care, as well as in acute care settings.
As the chief nurse executive, I believe that this experience was a healthy process to undergo. Through the process, quality of care was maintained, career security was not threatened, and participatory management was exercised, all without added cost or resource allocation. Healthcare in the United States is changing on every level. No doubt what we have arrived at today will need to change in the future. Working through this redesign process has given us the confidence to know that we will be able to change with the changing needs of our patients and payers.
Sharon Coulter, RN, MN, MBA, CHE
The Cleveland Clinic Foundation is a multi-specialty, academic medical center, recognized as a National Referral Center and an international health resource. This includes a 928 bed tertiary hospital, an 800 member multi-specialty physician group practice, a Research Institute, and Educational Foundation. It has also created an integrated delivery center which includes community hospitals, ambulatory care centers, rehabilitation services, subacute and home care services.
Sharon Coulter is the Chair of Patient Care Operations and is responsible for nursing and patient care support operations. The major challenge faced is how to provide excellent patient care in the face of declining revenues. This pilot was undertaken to help us better understand how redesign could help with that challenge.
The author gratefully acknowledges the contributions of the following CCF nurse staff in the development of this article: Linda J. Lewicki, RN, MSN; P. Mardeen Atkins, RN, BSN, MPA; Sandra S. Shumway, RN, MSN.
Article published January 6, 1997


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Managing Session State for ASP.NET
An HttpSessionState property named Session is a key and value dictionary that can store Serializable objects. The Session property is accessible through an HttpContext or a Page object. You can use the Session object to store information for an individual session, which can be a user, browser, or client application.
The session cache is easy to use, durable (storing data between IIS restarts), scalable for multiprocessor and multi-computer environments, and works with browsers and devices that don't support cookies. Adding data to the session cache is straightforward. We'll take a quick look at how to get data into the Session as well as how and why to configure different kinds of session state servers.


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Event Series: Cars & Coffee
Cars & Coffee
December 13, 2025 @ 7:00 am - 9:30 am
Every month the 1st & 2nd Saturday, 7:00am-9:30am rain or shine. Cars and Coffee started in 2014 as a way for car people to meet up and hang out early on Saturday Mornings. Over the last 9 years it has grown into a very respected family and community-based event where everyone and every type of vehicle is welcome. Their motto is "If it rolls, it goes" Come check out the cars and enjoy free coffee and donuts, while they last. No registration is needed. Located in the right-side parking lot of the Regal movie theater.


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Alix d. Reynis Hera Necklace
Alix d. Reynis Hera Necklace
Alix d. Reynis Hera necklace.
The circles of the Hera collection evoke the cycles of femininity of which the Greek goddess is the protector. It can be worn alone or in combination with our other jewelry pieces.
Necklace in vermeil (5 micron gold plated silver).
Chain length: 50cm
- Medallion diameter 1.2cm
This jewellery is entirely handmade in Paris. Starting from a meticulously sculpted wax, the model is then reworked in metal. Once the harmony is found, a mould is made from which the silver or gold proofs will be drawn. With these tests on precious metal, the work of the jeweller is to file the cast iron jets, braze the rings and finishes, crimp the stones and polish the pieces. These pieces are sterling silver with an 18-carat gold vermeil and semi-precious stone.
Save on shipping and pick up your purchase from the shop! Select PICK UP at checkout.


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Events at Physics |
Events During the Week of November 17th through November 23rd, 2013
Monday, November 18th, 2013
- Cosmology Journal Club
- An Informal discussion about a broad variety of arXiv papers related to Cosmology
- Time: 12:30 pm
- Place: 5242 Chamberlin Hall
- Abstract: Please visit the following link for more details:
Please feel free to bring your lunch!
If you have questions or comments about this journal club, would like to propose a topic or volunteer to introduce a paper, please email Le Zhang (email@example.com) - Host: Peter Timbie
- Condensed Matter Theory Group Seminar
- Tunnel-Fluctuoscopy: Fluctuation Induced Low-Bias Anomaly
- Time: 4:30 pm
- Place: Chamberlin 5310
- Speaker: Andrey Varlamov, CNR-SPIN, Rome, Italy
- Abstract: Electron tunneling spectroscopy pioneered by Esaki and Giaever offers a powerful tool for studying electronic spectra in superconductors. The phenomenological theory by Giaever and Megerle related the tunneling current to the electronic densities of states and to the difference of their equilibrium distribution functions in electrodes. This led to impressive discoveries having revealed, in particular, of the wide, pseudogap in the tunneling spectrum of superconductors above their critical temperatures. However, it turns that this standard approach is insufficient to reveal the nontrivial, related to Andreev reflection of the tunneling electrons from superconducting fluctuation domains in the biased electrode, zero-bias anomaly carrying important information about the scattering, interactions, and decoherence. Here, operating in frameworks of the microscopic theory of tunneling, we report the existence of a such low-energy singularity in a tunneling conductivity of N-I-N(S) junction directly indicating on the presence of fluctuating Cooper pairs. Our findings mark a radical departure from the conventional picture of the ZBA and open new horizons for quantitative analysis of electronic spectra of superconductors in fluctuation regime.
- Host: Maxim Vavilov
Tuesday, November 19th, 2013
- Chaos & Complex Systems Seminar
- A historical introduction to quantum computing
- Time: 12:05 pm
- Place: 4274 Chamberlin (refreshments will be served)
- Speaker: Marty Lichtman, UW Department of Physics
- Abstract: The quantum computer is on the horizon. If a system is small enough and isolated enough, it behaves according to the weird laws of quantum mechanics. One of the beautiful behaviors of a quantum system is that it can exist in a "superposition" of multiple states, at the same time. In the last two decades, physicists, including the 2012 Nobel laureates, have learned to control these systems. If we think of the state of these systems as a piece of information, we can store a superposition of data. Then by manipulating the system, a calculation is performed. The power of this quantum computation is that many calculations may effectively be performed at the same time. The potential speedup is immense. A functional quantum computer will certainly bring advances in cryptography, search, and physical simulation, and likely in all areas of science that have hard computational problems. This talk will present the development of the quantum computer in the historical context of classical computing. We will discuss the basics of how a quantum computer can speed up certain calculations, and also look at one experimental attempt to build a quantum computer using trapped neutral atoms here at UW-Madison.
- Host: Clint Sprott
- Theory Seminar (High Energy/Cosmology)
- Detecting dark Matter sub halos with Gaia
- Time: 4:00 pm
- Place: 5280 Chamberlin Hall
- Speaker: Douglas Spolyar, Institut d'astrophysique de Paris
- Abstract: Cold Dark Matter (CDM) theory, a pillar of modern cosmology and astrophysics, predicts the existence of a large number of starless dark matter halos surrounding the Milky Way (MW). However, clear observational evidence of these "dark" substructures remains elusive. Here, we present a detection method based on the small, but detectable, velocity changes that an orbiting substructure imposes on the stars in the MW disk. Using high-resolution numerical simulations we estimate that the new space telescope Gaia should detect the kinematic signatures of a few starless substructures provided the CDM paradigm holds. Such a measurement will provide unprecedented constraints on the primordial matter power spectrum at low-mass scales and offer a new handle onto the particle physics properties of dark matter.
Wednesday, November 20th, 2013
- Physics Educational Innovation Forum
- Organization Meeting
- Time: 12:15 pm
- Place: 5310 Chamberlin Hall
- Abstract: The PEI Forum is for faculty, graduate students and staff to meet informally to discuss new ideas for teaching physics. At this first meeting we will hear about two initiatives in the Dept and make plans for future meetings:
1)Social bookmarking to facilitate journal and news reading and discussion in physics classes - why, how, results - Duncan Carlsmith
2) A new tool for quantitative assessment of student problem-solving skills - Tor Odden - Host: Duncan Carlsmith and Peter Timbie
Thursday, November 21st, 2013
- R. G. Herb Condensed Matter Seminar
- Probing the chiral anomaly with nonlocal transport in Weyl semimetals
- Time: 10:00 am
- Place: 5310 Chamberlin
- Speaker: Dmytro Pesin, University of Utah
- Abstract: Weyl semimetals are three-dimensional crystalline systems where pairs of bands touch at points in momentum
space, termed Weyl nodes, that are characterized by a deinotnite topological charge: the chirality. Consequently,
they exhibit the Adler-Bell-Jackiw anomaly, which in this condensed matter realization implies that application of parallel electric (E) and magnetic (B) inotelds pumps electrons between nodes of opposite chirality at a rate proportional to E*B. We argue that this pumping is measurable via nonlocal transport experiments, in the limit of weak internode scattering. Speciinotcally, we show that as a consequence of the anomaly, applying a local magnetic inoteld parallel to an injected current induces a valley imbalance that diffuses over long distances. A probe magnetic inoteld can then convert this imbalance into a measurable voltage drop far from source and drain. Such nonlocal transport vanishes when the injected current and magnetic inoteld are orthogonal, and therefore serves as a test of the chiral anomaly. Since the nodes are analogous to valley degrees of freedom in semiconductors, this suggests that valley currents in Weyl semimetals can be controlled using electric inotelds, which has potential practical aEuro~valleytronicaEuroTM applications.
- Host: Perkins
- NPAC (Nuclear/Particle/Astro/Cosmo) Forum
- First Evidence of High-Energy Extraterrestrial Neutrinos at IceCube
- Time: 2:30 pm
- Place: 5280 Chamberlin Hall
- Speaker: Claudio Kooper, UW - Madison
- Abstract: The spectrum of cosmic rays includes the most energetic particles ever observed. The mechanism of their acceleration and their sources are, however, still mostly unknown. Observing astrophysical neutrinos can help solve this problem. Because neutrinos are produced in hadronic interactions and are neither absorbed nor deflected, they will point directly back to their source. This talk will cover searches for high-energy neutrinos (> 100 TeV) at the IceCube neutrino observatory, which have recently produced the first evidence for a flux beyond standard expectations from neutrinos generated in the Earth's atmosphere. This includes the detection of two events with energies above 1 PeV -- the highest energy neutrinos ever observed. The current status of these astrophysical neutrino searches and prospects for the future will be discussed.
- Host: Karle
- Astronomy Colloquium
- Constraining the Physics of Star Formation in Galaxies Using the JVLA and GBT
- Time: 3:30 pm - 5:00 pm
- Place: 4421 Sterling Hall
- Speaker: Amanda Kepley, NRAO
- Abstract: Understanding how galaxies evolve requires understanding the properties of the young massive stars that mediate their structure and evolution and understanding the conditions under which these stars form. The latest generation of radio and
submillimeter telescopes are revolutionizing our ability to probe both the young massive stars and the dense molecular gas out of which they form. In this talk, I will present observations from the JVLA and GBT that demonstrate the capabilities of these telescopes and how they can tell us about the properties
of the dense gas ionized by the young massive stars in the center of a galaxy much like our own and the properties of the dense molecular gas in a starburst environment. - Host: Professor Eric Wilcots
- Outreach and Education
- Chasing the Ghost Particle Premiere
- Time: 7:30 pm
- Place: Milwaukee Public Museum
- Speaker: Prof Francis Halzen
- Abstract: You are invited to the November 21 premiere of the planetarium show Chasing the Ghost Particle: From the South Pole to the Edge of the Universe, a 30-minute film about the construction and science of the IceCube Neutrino Observatory. The premiere and first run of the movie will be held at the Milwaukee Public Museum.
Professor Francis Halzen, IceCube principal investigator, will give a short introduction starting at 7:30 pm. The show will take you from the outer reaches of the universe to inside the IceCube detector, some 2,400 meters under the Antarctic ice.
Admission to the premiere is free, but seats are limited. Reserve yours today by contacting the box office at email@example.com or 414-278-6951.
Friday, November 22nd, 2013
- Theory Seminar (High Energy/Cosmology)
- The Holomorphic Higgs Portal -- General Methods for the Higgs Lagrangian
- Time: 2:00 pm
- Place: 5280 Chamberlin Hall
- Speaker: Piyush Kumar, Yale University
- Abstract: We develop a systematic and general approach to study the Effective Higgs Lagrangian in a framework in which the Higgs fields in the visible sector couple to another sector via the superpotential. The extra sector is assumed to be super-conformal in the ultra-violet (UV) but develops a mass-gap with supersymmetry breaking in the infra-red (IR) close to the TeV scale. The main technique used in the approach is that of the Operator Product Expansion (OPE). By using OPE methods, we are able to compute the parameters in the Higgs Lagrangian to quadratic order and make general statements that are applicable to many classes of models. Not only does this approach allow us to understand the traditional problems plaguing simple models from a deeper perspective, it also provides new possibilities for solutions of these problems. The methods and results of our work should be very useful in eventually constructing a fully viable electroweak-natural model of Beyond-the-Standard Model physics.
- Physics Department Colloquium
- First results from the LUX dark matter experiment at the Sanford Underground Research Facility
- Time: 3:30 pm
- Place: 2241 Chamberlin Hall (coffee at 4:30 pm)
- Speaker: Daniel McKinsey, Yale University
- Abstract: The LUX (Large Underground Xenon) experiment aims at the direct detection of dark matter particles via their collisions with xenon nuclei. The 350 kg two-phase dual-phase xenon time-projection chamber operating at the Sanford Underground Research Facility (Lead, South Dakota), was cooled and filled in February 2013. Results of the first WIMP search dataset, taken during the period April to August 2013, corresponding to 85.3 live-days of data with a fiducial volume of 118 kg, are presented.
- Host: Bai


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Google's future campus looks like a sci-fi utopia
Google has revealed eye-popping ideas for a redesign of its California headquarters that symbolize how far the company wants to move beyond its core search business.
Plans submitted Friday to the Mountain View City Council include lightweight block-like structures—not stationary concrete buildings—that can be moved around as the company invests in new product areas. These areas now include self-driving cars, solar-powered drones and robots. Google's self-driving car team, for instance, has different needs than search engineers, the company said in revealing its plans.
On top of those modular structures would be translucent canopies that can control the climate inside while letting in natural light and air. The canopies would free the spaces from traditional limitations like walls, windows and roofs.
It's not hard to imagine Google's future campus serving as a playground for the company's pursuits outside of search. Plus, it sounds like Google is going for something like a futuristic city for its thousands of employees and local residents. The company is already known for its on-campus perks encouraging employees to maximize their time on campus, but the new plans elevate that concept.
Different segments within the buildings' canopies will "form small villages" where employees can work or relax, the company said, while Mountain View residents can enjoy cafes and parks, "or work in the public community gardens."
Also, a new structure would consolidate parking, while underutilized areas will host "native ecosystems," including wetlands and re-integrated oak trees, the company said.
Of course, this all has to be approved by the Mountain View City Council, and that could take a year or longer. Google already faces some pushback from local residents who haven't been happy with the rising traffic congestion and booming housing prices tied to the company's growth. To be approved, Google's plans must include a proposal for improving traffic conditions, a spokeswoman for the city council said Friday.
The plans, if approved, would increase Google's square footage by the millions in the North Bayshore area of Mountain View, California.
Meanwhile, other Silicon Valley giants like Apple and Facebook have plans of their own for new or expanded campuses. Apple is planning a new headquarters resembling a spaceship in nearby Cupertino, while Facebook is building an addition designed by architect Frank Gehry.
Take a look at the pictures. The concepts mark the first time Google has designed offices from scratch. The plans were developed by Danish architect Bjarke Ingels and English designer Thomas Heatherwick.
Source : pcworld.com