Dale Bloomquist, DDS, MS

• Acting Chairman, Department of Oral and
• Maxillofacial Surgery
• University of Washington
• Private Practice - Orthognathic Surgery
• Seattle, Washington

Consistent with an evacuation plan skin79 skin care proven 8mg decadron, Agent Bernazzani evacuated all of his agents except for himself and three volunteers to protect the feld ofces classifed information acne under the skin decadron 4mg, communications systems skin care yoga decadron 1mg low cost, weapons and ammunition acne holes in face purchase 0.5mg decadron otc. However skin care must haves 0.5 mg decadron otc, as of September 1 skin care after 30 purchase decadron line, ffy-one employees of the New Orleans-based Field Ofce could not be located. Reconstitution eforts were further hampered by local evacuation and continuity of operations plans that relied upon cell phone coordination amongst agents and the Field Ofces own telecommunications hub, which was decimated. James McAtamney, e-mail to William Mercer, Teodore Ullyot, and Jefrey Taylor, Requests for Federal Law Enforcement Support, Sept. Blum, these deployments restored a signif cant degree of order by September 1, and that things were basically under control by September 2. Committee staf interview of Wendell Shingler, Director, Ofce of Federal Protective Service, U. The Attorney General may consult as necessary with Department ofcials and has 10 days to respond. Communities devastated by hurricanes, tornadoes, foods and other similar calamities have benefted from coordinated federal response to these emergencies. Tere is, however, no coordinated Federal response to the existence of a man-made disaster. Similarly, Federal law enforcement ofcers are authorized to intervene in riots, but there is not [sic] organized mechanism for responding in a less blunt way. House Committee on the Judiciary, Report on the Justice Assistance Act of 1983, Report No. The term law enforcement emergency is defned as an uncommon situation which requires law enforcement, which is or threatens to become of serious or epidemic proportions, and with respect to which State and local resources are inadequate to protect the lives and property of citizens or to enforce the criminal law. See also: Committee staf interview of William Mercer, Principal Associate Deputy Attorney General, Ofce of the Attorney General, U. In addition, the Staford Act authorizes federal agencies, upon direction of the President following a major disaster declaration, to provide assistance, including any work or services es sential to saving lives and protecting or preserving property and public health and safety, without a request from a governor (Sec. However, it is unclear whether the President contemplated or directed the Attorney General pursuant to this provision to deploy federal law enforcement to the region. McAtamney, who also works in that ofce, about what the overall Justice coordinated efort would be. What, any guidance that would come from the attorney general to all the Justice components about what authorities wed be acting under and what our response would be. Lets pre-identify all the assets that Ive got all these emergency vehicles from every agency. Lets get them all located in one place so that we know, so when time comes and we ask for them, we know who the point of contact is. Were not scrambling to fnd out what do you have, who can do it, and how soon can you get there Tere are a number of very sensitive legal/perhaps constitutional issues with this. All such ofcers engaged in this mission shall coordinate with their state and local counterparts to make appropriate arrangements as necessary to ensure the most efective law enforcement assistance eforts in the State of Louisiana. In addition, all such ofcers shall be subject to the supervision of the United States Attorney for the Eastern District of Louisiana, who may delegate operational authority to appropriate Department of Justice ofcials. Instead, law enforcement support is provided within the overall umbrella of the Department of Homeland Securitys coordination function under the authority of the Staford Act or pursuant to inherent authority of the individual law enforcement agencies. And what we had independent authority to do was to add a bunch of Federal resources to the af fected area, which is what we did. Others built a boat launch in Plaquemines Parish for use in rescue operations; coordinated relief mission planning in St. Many residents of the home had already died as a result of dehydration and a lack of medical care. They were transported to a shelter outside of the City of New Orleans on the West Bank of the Mississippi River to safety. Drug Enforcement Administration, New Orleans Field Division, Hurricane Katrina Events Log, Aug. Incident management coordina tion may include: (1) supporting operational and tactical planning activities to prevent or mitigate potential incidents or threats to public safety, (2) the deployment of federal resources in response to such incidents or threats, (3) providing tech nical assistance in planning and assessment eforts, (4) establishing badging and credentialing processes, (5) helping control access to the incident site or critical facilities, (6) conducting trafc and crowd control, (7) protecting emergency responders and other relief workers, (8) protecting the people, facilities and supplies during distribution eforts; 9) providing surveil lance support; and 10) supplying specialized equipment, clothing, and gear as needed. By comparison, tactical coordination suggests lower level commanders of on-scene, operational units eforts to achieve micro-level ends via communication and cooperation with other, similarly situated commanders 464 on the ground. Public Safety and Security 182 Michael Vanacore, e-mail John Clark and others, Sept. Whitehorn cited the United States Secret Service for establishing a key credentialing process, while Jeferson Parishs Sherif Harry Lee generally thought he received good support from federal agencies. By later in the week we had tremendous response with hundreds of federal agents from all the federal agencies. The Statutes and Role of the National Guard in Emergency Response National Guard units conduct operations in one of three modes: (1) under control of their governor as commander-in-chief, on state active-duty status, with the state paying salaries and expenses; (2) under gubernatorial control, but operating under Title 32 of the U. Code, with the federal government paying mission costs;1 or (3) under control of the President, having been federalized under provisions of Title 10 of the U. Governors routinely use their states National Guards for disaster-relief missions when local frst responders are overwhelmed. The Directive also clearly states that the Secretary of Defense shall retain command of military forces when such forces are providing civil support. Uses own resources to provide own communications and coordinates numerous other 2. Communications 25 communication issues with the Federal Emergency Communications Coordinator. Public Works and Army Corps of Engineers provides technical assistance, engineering, and construction Engineering management. Mass Care, Housing, Army Corps of Engineers provides ice and water; inspects shelter sites for suitability; and Human Services and assists in construction of temporary shelters and temporary housing repair. When requested, serves as a primary source for rotary and xed-wing aircraft to sup 9. Urban Search port urban search-and-rescue operations; and Army Corps of Engineers provides (1) and Rescue certain training and structural integrity analysis, (2) assessments of whether buildings are safe to enter, (3) building stability monitoring, and (4) other services. Oil and Hazardous of hazardous materials from its vessels, facilities, vehicles, munitions, and weapons; Materials Response and Army Corps of Engineers provides response and recovery assistance involving radiological dispersion devices and improvised nuclear devices. Agriculture and technical assistance; and assists in animal emergency response; develops appropriate Natural Resources plans; and the Army Corps of Engineers provides expertise and resources to assist in removal and disposal of debris and animal carcasses. Public Safety and If directed by the President, quells insurrection and provides physical and electronic Security security-systems assistance and expertise. Long Term Provides technical assistance in community planning, civil engineering, and natural Community Recovery hazard risk assessment and supports national strategy development for housing, and Mitigation debris removal, and restoration of public facilities and infrastructure. External Affairs No specic role identied other than to provide support as required. Tese statutes 469 establish pre-disaster and disaster-response reimbursement procedures, authorize the use Chapter 26 of military forces to put down insurrection, and generally prohibit the use of military forces for law-enforcement purposes except to put down insurrection and in certain other limited circumstances. Economy Act The Economy Act permits federal agencies to provide goods or services to another federal agency when such support is requested. Staford Act reimbursements are authorized once a governor has asserted that state capabilities are overwhelmed and federal assistance is needed, and the President has declared an emergency. Specifcally, the President may employ military forces to restore order, prevent looting, and engage in other law-enforcement activities. Congress enacted the law to restrict the use of fed eral troops in the conduct of law enforcement in the South during Reconstruction. The Act does not apply to the National Guard when under the direct command of a states governor. Code establishes the armed services; defnes their organization, missions, and general military powers; specifes personnel limits; defnes training and education re quirements and organizations; and specifes service, supply, and procurement roles. Gener ally, under Title 10, the military departments defne training requirements, and design and implement the training. Atlantic Command as the planning agent for military support missions,61 although that command was re-designated in October 1999. Northern Command, even though that command began operations on October 1, 2002, to carry out the types of domestic missions contemplated in the Directives. The Quadrennial Defense Review released in February 2006 addressed the use of military forces in domestic disaster-relief eforts. It pointed out that the ability of military forces to mitigate the efects of an attack on the homeland may also be useful for disaster-relief operations. Code, the Departments of the Army, Air Force, and Navy organize, train, and equip the force, among other things. In addition, the Departments identify, develop, and deliver training deemed appropriate to prepare the forces for their mission. Lastly, the Depart ments develop and acquire the weapons systems, equipment, and supplies needed by the forces to successfully carry out their missions. Forces temporarily assigned to Northern Command can be pulled from anywhere in the force structure, but generally consist of forces based in the United States which are not already deployed on another mission. Department of Defense Response Introduction [Te] movement of 72,000 men and women in military uniform within the United States is the largest deployment of military capability within our coun try since the Civil War. He few in by his helicopter, grabbed me and said, okay, Im going to go orient you to your mis sion your job is to fx the airport and fx New Orleans. Although individual commanders exercised their own initiative to pre pare, identify, and alert troops as a result of the forecasted magnitude of Katrina, and had expedited certain procedures, these actions were not coordinated by senior leaders of the Department. One of the lessons from Katrina is that these procedures are inadequate for a catastrophic incident. The Chair man of the Joint Chiefs of Staf directed the chiefs of the various services to begin deploying forces they believed might be needed for the response. This third phase of the response rep resented the type of approach that may be necessary in a catastrophic incident: anticipating requests and deploying assets in advance of requests. The resulting movement of 50,000 National Guard and 22,000 active-duty troops in response to Katrina was the largest deployment of military capability within the Unit ed States since the Civil War. The National Guard and active-duty military response provided critical humanitarian relief that saved lives and eased the sufering of thousands. Many of the state and federal requests for military support, however, lacked adequate speci fcity. The responses to the requests for military support ofen were poorly coordinated with each other, if at all. The deployments of the National Guard troops were not well coordinated with the active-duty forces. One result was that local, state, and federal ofcials had difering perceptions of the numbers of federal troops that would be arriving, the missions they would be performing, who was in command of the military forces, and who should be in command. However, recognizing that 2005 was forecast to be a well above-average hur ricane season with an above-average probability of a major hurricane landfall in the United States, the Secretary and the Joint Staf wanted to provide additional fexibility in advance of the hurricane season, and on Friday, August 19, issued the Severe Weather Execute Order. So it was a big deal, and it proved to be very helpful, and allowed us to respond in a much quicker fashion than would normally have been the case last year. On August 23, Colonel Chavez learned of what would become Hurricane Katrina when the National Hur ricane Center began tracking Tropical Depression 12. Indeed, he said his ofce had intended to formalize these anticipatory actions into a pre-storm checklist, and now plans, as a result of Katrina, to expand the scope of the inventory to include other foreseeable needs such as shallow draf boats. According to General Honore, First Army had begun track ing the tropical wave that would become Katrina on August 8,110 well before it appeared as a tropical depression on the Pentagons screen. He wanted the necessary equipment and personnel identifed and alerted in advance so as to expedite their eventual deployment. The order, howev er, instructed him to deploy without the full complement of staf, or Defense Coordinating Element, that would normally have accompanied him, and instead to deploy two planners. He explained that the decision to deploy only two planners was based on uncertainty as to Katrinas path and limited lodging space in Baton Rouge. They discussed the weather predictions and the potential severity of Katrinas impact. The Bataan ofers a large fat deck, refueling capacity, vast hanger space for cargo transport, and substantial medical facilities. Additionally, the Navy followed standard pre-landfall procedure by moving ships in the storms path out to sea. Five supply and logistics vessels lef New Orleans for the Gulf of Mexico, remaining close enough to provide assistance as soon as Katrina passed. Aircraf departed from the Gulf Coast for protection, but Construction Battalion engineers (Sea bees) in Gulfport, Mississippi, equipped with heavy-lifing vehicles and trained to build or rebuild structures quickly, sheltered from the storm locally in order to respond quickly if required. General ODell evacuated his headquarters on Friday, August 26, to avoid the approaching storm. Realizing that transportation assets were the most difcult to move quickly and would be the linchpin if a fast response were required, he conducted assessments of the most important of these enablers: amphibious vehicles; motor transport in the event that infantry were deployed or a large evacuation were required; and a command-and-control element to receive and direct forces. Navy photo whose mission is to deploy to a damaged airfeld, and rapidly repair the runway, lighting, navigation, and communications systems to restore aircraf operations. Many of the frst responders were immobilized by damage or fooding, and communications systems were incapacitated. The challenge of obtaining rapid and reliable information about hurricane damage is not new. General Richard Myers, Chairman of the Joint Chiefs of Staf during the Katrina response, said, I dont know if we have a 21-step process or not.

For example skin care after 30 generic decadron 0.5 mg without a prescription, a light-skinned Indian woman who occupies the lowest strata of Indian society in terms of caste and class may have increased prospects in areas such as employment and marriage than a darker woman of similar status skin care laser clinic buy 4 mg decadron visa. In short acne cream buy decadron 1mg free shipping, there are numerous moving parts that contribute to the complexity of examining pigmentocracy acne holes in face decadron 4mg with visa. Yet skin care 4u best decadron 8mg, larger patterns also exist that allow for a comprehensive understanding of how pigmentocratic notions influence and are influenced by multiple background and demographic conditions acne vitamin deficiency cheap decadron 8mg visa. The marginalization of darker Indians serves to further fragment efforts towards equality and solidarity. For example, colorism disproportionately impacts women in India, yet there is a lack of feminist scholarship that problematizes its oppressiveness. As such, pigmentocracy calls 3 for feminists to reiterate the need to re-theorise the fundamental causes of womens oppression in post-independent India (Ghosh, 2005, p. Benefits for those who are on the lighter end of the skin color spectrum are recognized and leveraged in accordance with the systemic logic of being naturally superior. Conversely, often those on the darker end of the spectrum are perceived as inferior (by others as well as themselves), thus perpetuating the superiority of whiteness, and consequently the ramifications contained within the typifications. The correlative relationship between color, caste, and class is not logical or natural; rather it is a performative construction manifested as a means for dividing and vertically organizing Indian society. Disembodied expressions of whiteness and racism are transmitted through mediums such as the cultural, imperial, lingual, symbolic, historical, discursive, and conceptual. Whiteness, as a social construction, is also fluid and elusive in its constantly shifting points of reference. The idea of whiteness and who is white (categorically) is continuously changing and must also be considered in relation to pigmentocracy. Statement of Problem: Maleviolent Effects of Pigmentocracythe disadvantages of intraracial racism are less recognizable and quantifiable than interracial racism, but nonetheless prevalent in Indian society. Due to the intraracial nature of pigmentocracy, oppressive conditions are often attributed to caste, class, and gender differentiations while discounting color. Furthermore, discrimination resulting from skin color is difficult to identify and address among intraracial groups. Darker skin is often viewed (by society, media, lighter individuals as well as darker people who subscribe to the belief that white is better) as less attractive, less valuable, less pure, and less clean. For those perceived to be darker, the consequences can include violence, marginalization, discrimination in areas of employment, education, government, access to resources, psychological trauma, disparities in marital opportunities and conceived notions of beauty, underrepresentation in media, and countless others. Darker Indians face discrimination by other Indians as demonstrated through lower incomes, less education, and lack of access to coveted government positions. Due largely in part to the intersection of gender, color, and caste, they have fewer available opportunities. For example, the outcaste groups of Dalits are racialized as black and have limited access to occupational sectors. As a result, Dalits are often relegated to unwanted professions including waste management, toilet cleaning, prostitution, and servants to the middle and upper classes (Gangoli, 2007). The stratification of Indian society by caste, religion, class, region, gender, and particularly color are detrimental to Indians as a whole, as individuals, and as an emerging nation. These taxonomies promote the creeds of colonialism and western imperialism, which preserves power and wealth in the hands of the elite, who in turn maintain dominance through continued oppression of the masses. While it is my contention that cultural forms such as media and aesthetic standards are the prevailing medium for influencing the masses, the political sphere of life is not left unaltered. The ongoing discrimination of darker members of society and the material and ideological subjugation of the (Oriental) Other through neocolonial structures has had profound impact on 5 areas of government. This includes underrepresentation of darker and/or lower caste Indians in government, which also correlates with unequal representation in media and state employment. Furthermore, darker members of society face political obstacles in elections as lighter and higher caste candidates are more likely to triumph due to more available financial resources (a symptom of neocolonialism and capitalism) and/or racial discriminants (Gangoli, 2007). Those who accept the seemingly natural system of colorism also internalize the essentializing logic of pigmentocracy. The result is a consciousness informed by lack of self worth stemming from feeling ugly, rejected, unclean, insignificant, and pitiable. As a result of the real material advantages of being lighter-skinned, and the internalized idealization of lighter skinned, those who are identified and/or who self-identify as being dark often seek to assimilate st to the dominant culture. Ronald Hall, editor ofthe Melanin Millennium: Skin Color as 21 Century International Discourse, argues that many subjugated groups are aware of the discriminatory practices in place and psychological/physical harm ensues from assimilation. For example, many Indians use skin-bleaching products, despite the fact that many have harmful side effects. In patriarchal India, women are affected at higher rates by pigmentocratic prejudice. In regards to gendered and racialized exploitations, darker women are more likely to be objectified and dehumanized than their lighter skinned counterparts (though all women suffer this condition to an extent in a patriarchal society). Furthermore, they experience increased incidences of violence, rape, domestic abuse, and prostitution. The view that dark bodies are less significant also contributes to maltreatment and commodification as they are more frequently the victims of 6 the sex trade (Gangoli, 2007). Additionally, due to the fact that darker women are frequently perceived as less valuable, marital options are limited and dowries are usually higher. As is often the case in patriarchal cultures, standards of beauty (though subjective) can affect how societies (and women themselves), measure female value. Though colorism is closely linked to beauty standards, it also extends beyond the realm of attractiveness and includes socioeconomic exploitation of dark skinned women as menial workers, less deserving of material comforts, and targets of the skin bleaching market. To combat the prospect of a female member of a household falling into an undesirable category, many families and communities continue to reproduce the belief that a females place is in the home. As fairness and virtue are the overwhelmingly feminine ideals, the practice of keeping females indoors is motivated by colorist ideologies as well as fear of mingling with men 1 (thus bringing about badnam). These perils further devalue a girls worth and thus increase familial burden, particularly those of a financial nature, as dowries for darker and/or immoral brides are higher in order to compensate for their aesthetic inadequacies and lack of piety. The terms goreh and chitti are Hindi terms often used by Indians in conjunction with one another in describing skin color. The former is employed when describing white people (such as colonialists), but is also used to refer to lighter skinned Indians. The terms chitti literally means white and can refer to color in general (for example: white garments) as well as skin color. Light skinned (or goreh/chitti) domesticated Indian women accordingly become the desired exotic Others to the poorer, darker, lower caste, and/or Dalit women. Although sharing similar subjugations, depending on their skin color and caste, Indian women are also positioned in very specific ways due to color. The norms and values constructed by this institution and communicated through the vehicle of culture has become equated with reality and truth. The preference for lighter skin is a vehicle for fulfilling male fantasies of the ideal woman (in terms of beauty, morality, and prestige). Males are not subjected to this standard to the same extent in patriarchal societies. As the dominant group, their value is often derived from non-aesthetic factors, such as education and occupation. This is most evident in the emphasis grooms and their families place on fair skin when seeking brides. Lighter women are considered both by themselves as well as others, to be the haves rather than the have nots. Mercurials and lead-based products are officially banned in India, but many of these products are widely available on the black market. The possible side effects of these ingredients are dangerous and include kidney damage and neurological symptoms (anxiety, depression, and psychosis) (Jablonski, 2012, p. The vast majority of skin bleaching products (or cosmetics as they are often misleadingly referred to by manufacturers) originate from western companies. In response to criticisms of unethical business practices (in the neocolonial sense as well as the implications of their goods), skin bleaching product manufacturers claim it is the demand of the nonwhite market that fosters 2 Although bridal dowries are officially illegal, they are still widely practiced. The more prominent companies include Vaseline, Dove, Fair & Lovely (all of which are owned by the Anglo-Dutch parent company, Unilever), LOreal, Garnier, Lancome (all French companies), Nivea (owned by the German company Beiersdorf), Oil of Olay, Neutrogena (owned by American company Procter & Gamble and Johnson & Johnson respectively), and the Body Shop (an Anglo-French company owned in part by LOreal). In addition, the European conglomerate Unilever has an Indian based division called Hindustan Unilever, which markets Fair & Lovely and Fair & Lovely Menz Active (Russell Cole, et. By positioning Fair & Lovely as made by Indians and for Indians, Unilever markets itself as serving Indian interests and while maximizing Indian nationalism. Roadmap of Dissertationthe unmarked white body conveys an absence of the problematic principles reserved for nonwhite races (Garner, 2007). Similarly, the invisibility of whiteness to many whites allows for the concealment of its advantages (Dyer, 1997). Conversely its visibility to nonwhites communicates the lack of disadvantages inherent in whiteness. I argue that the racial identities of nonwhites are informed by whiteness and that the non-raced identities of whites are predicated on the racialization of nonwhites. In other words, whites derive their whiteness (and absence of race) through the racialization of all other groups. Additionally, understanding the why, who, what, how, and when of whiteness studies can provide valuable insight into pigmentocracy. Recognition of the multifaceted manifestations of whiteness achieved through white self-analysis could contribute to the destabilizing of foundational premises and lead to the questioning of white rationale, motivation, and subsequently, superiority. Furthermore, whiteness studies can also contribute to the demystification of white privilege by recognizing and demonstrating how systemic and localized unearned advantages endure. Epistemologies of the oppressors can also contribute to our undestanding of the mutability of whiteness. Specifically, the ways in which who is designated and/or included as white shifts contextually. Colonialism contributes to the perpetuation of whiteness and masculinity as superior not only through domination, but also through the deepening of social stratification of Indian society. The colonial experience left lasting impressions on Indian culture in regards to perceived advantages of lighter skin and masculinity. For example, British colonialists and settlers principally affiliated with upper caste elites, thus further increasing and instituting the legitimacy of power and supremacy over the masses. Race distinctions promulgated by white British colonialists served to refuse sovereign power to Indians, yet authority was bequeathed to non-white elites. Relative to the British, the power elite Indians held was excessively limited, but relative to non upper caste/class Indians, was imposing. In this way, whiteness and wealth (as exemplified by both whites and their elite Indian allies), constructed hierarchical structures using performative configurations entrenched in racialized aesthetics and affluence. Specifically, I refer to 10 Edward Saids articulation of cultural imperialism and Orientalism; Michel Foucaultsthe Archaeology of Knowledge; Max Horkheimer and Theodor Adornos discussion of mass culture; Kwame Nkrumahs theory of neocolonialism; Jean Baudrillards concept of simulations; and Parameswaran and Cardozas exploration of advertising white beauty. To begin, I critique the superiority of whiteness as having no historical basis in reality or truth. In doing so, I problematize the nature of historical discourse as it pertains to whiteness as products of subjective authors forwarding narratives towards specific ends. Furthermore, I theorize how whiteness has been transformed from the realm of imagined narratives to actual discourse. Like the representation of nonwhites, the Orient is framed for the specific purposes of promoting Western 3 superiority through subjugation and simulations. I further argue that racial identities are inherently problematic as they are often used (by whites) against those seeking terms of recognition. In an effort to apply the aforementioned conceptualizations of genealogy, representation, and identity to practical realities, I examine the role of mass culture and consumerism in perpetuating whiteness ideologies. For example, I refer to the skin bleaching products industry in India that has been steadily increasing since the liberalization of the Indian economy in the 1990s. Lastly, I submit methods for challenging truth claims, simulations, cultural imperialism, and mass deception. Additionally, I argue that Brahmins attempt to approach whiteness (ideologically, physically, etc. Using historical research, I provide an in-depth portrayal of the caste system, including the original prescriptions relating occupation and color, as well as modern day interpretations. Dalits comprise the lowest stratum of Indian society in terms of socioeconomic status (occupation, income, education, etc. Pigmentocracy has exhibited far reaching adverse effects for Dalits, who often suffer disadvantages that reveal a society still entrenched in hierarchal organization in which greater worth is assigned to the lighter and/or upper castes. The caste system in India establishes a hierarchy, which perilously subscribes to primordialist thought that grants privilege and superiority to certain groups as birthrights. Though the caste system was in place prior to British colonization of India, many scholars credit colonists for the oversimplification of the system. Accordingly, many subgroups of castes were disregarded in favor of larger classifications that could more easily organize the Indian population for the colonialists. As a result, the complexities of the caste system were lost to an arrangement based on occupation, skin color, and class as conceptualized through the lens of British colonialism. This constructed ideology proved to be advantageous to British colonizers who recognized the existing caste system and created further divisions to enact repressive strategies. Moreover, British colonists allied with upper caste/class Indians in the familiar strategy of divide and rule 4the genealogy of whiteness/lightness superiority is disputed among Indian historians, as is the parable of Aryan domination. The following are among the prominent theories: Aryans introduced color hierarchy; ancient Hindu scriptures pontificate the idea; British colonization implemented colorist divisions. Brahmins were often designated by English officials to serve in upper level positions of the public sector, including government 5 and military, and were rewarded disproportionate wealth and status. Subsequently, Brahmins became socio-politically, socioeconomically, geographically, ideologically, and racially estranged from lower caste Indians.

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Treatment consists of removing unabsorbed material from the gastrointestinal tract and supportive care skin care laser center order decadron on line. Brevetoxins are eliminated primarily in the bile acne hormonal imbalance cheap decadron 1 mg amex, although urinary excretion plays a signicant role acne under microscope cheap decadron 1mg online. Brevetoxin metabolites were detected in urine samples collected 3 hours postingestion but were undetectable 4 days later (24) skin care facts order on line decadron. The toxic dose of brevetoxins in humans has not been established acne reddit buy cheap decadron 8 mg line, although it is clear that eating only a few shellsh can result in severe intoxication tretinoin 025 acne buy generic decadron canada. Because metabolic conversion of the parent toxins occurs in shellsh, and metabolites are less pharmacologi cally active than the parent toxins, it appears at this time that immunological assays are preferable as screening tools. However, the question of secondary metabolism in humans may impact this issue, and it awaits further study. Fishing grounds are closed when cell counts are signicant and reopened when toxin activity in shellsh reach safe levels. Recre ational harvesters should keep abreast of closures and harvesting limitations set forth by state agen cies. This organism is an epiphyte, growing in association with lamentous algae on coral reefs and reef lagoons. As these precursors move up the food chain to higher trophic levels through predation, they are metabolically modied to form a family of very potent neurotoxins. The Pacic form of the toxin varies slightly from the Caribbean form, although both are long cyclic polyether compounds reminiscent of the brevetoxins. Large, predatory reef-dwelling carnivores such as grouper, snapper, barracuda, and jacks are especially recognized as frequent carriers of ciguatoxins. However, small reef-dwelling herbivores can also cause ciguatera, especially when consumed whole. This is especially true in the tropical Pacic, where these small herbivores are more widely eaten. Derivatization at R1 and R2 and less energetically favorable epimers make up the more than 20 members of this class. Even within endemic regions, however, it is highly variable and spotty in distribution. Difficulties in predicting toxic areas and detecting toxicity in sh has always been a major impediment to the implementation of control measures. In severe cases, symptoms can de velop in as little as 30 minutes; in milder cases onset can be delayed 24 hours or more. The early symptoms are typically gastrointestinal, including nausea, vomiting, diarrhea, and abdominal pain. These neurological symptoms occur in nearly all cases and are often accom panied by a wide range of other signs and symptoms (34). Fatigue, muscle and joint pain, and mood disorders such as anxiety or depression occur in 50% or more of cases (33). Severe cases may also manifest cardiac symptoms such as bradycardia and hypotension. There are also regional differences in symptomatology, probably resulting from regional differences in toxins (33). Although the gastro intestinal symptoms resolve early, neurological symptoms often persist for weeks or even months. Late in the course of recovery, symptoms may become episodic, recurring during periods of stress or after consumption of certain foods or alcohol. Like brevetoxins, ciguatoxins bind to neurotoxin receptor site 5 on the voltage-dependent so dium channel and cause a hyperpolarizing shift in the voltage dependence of channel activation (33). While not benecial in all cases, patients diagnosed early may respond to intravenous mannitol treatment (35,36). During the recovery period, avoiding the consumption of sh and alcohol are recommended. Ciguatoxins in sh are best detected with analytical methods such as liquid chromatography coupled to mass spectrometry. However, such analytical techniques are not useful for analyzing large numbers of samples. Because levels in sh tissues are typically in the parts-per-billion range or below, most techniques lack the required sensitivity. Development of immunological assays has been hindered by the lack of puried toxins with which to vaccinate animals for specic antibody production. Synthesis of the backbone structures is extremely difficult, but progress is being made for some of the Pacic forms (37,38). At present, the most useful in vitro assay available is still the competitive receptor-binding assay with rat brain membranes (18,31). This assay takes advantage of the fact that ciguatoxins and brevetoxins bind to a common receptor site and therefore radiolabeled brevetoxin can be used as the probe. It is sufficiently sensitive to detect ciguatoxins at levels that are believed to cause human intoxication but not to provide the desired safety margin for regulatory testing. Improved assays for these toxins are desperately needed in many parts of the world. At present, there is no regulatory guidance level for ciguatoxins and the commercial sh harvests are not monitored. Some local jurisdictions have implemented bans on the sale of certain toxic species. For consumers this means being aware of the local situation with regard to prevalence and implicated species. It is prudent to avoid eating locally implicated species in particular and large coral reef-dwelling predators in general. Although screening individual high-risk sh is not yet fully feasible for either the seafood industry or the individual consumer, research continues for new assay technologies to achieve this goal. Diarrhetic Shellsh Poisoning Diarrhetic shellsh poisoning occurs after consumption of shellsh containing okadaic acid or its derivatives. Okadaic acid was named for the black sponge Halichondria okadai, from which it was rst isolated. However, it was later determined that the origin of the toxin was actually dinoagellates of the genera Prorocentrum and Dinophysis. It occurs seasonally and is a major problem to the shellsh industry in Europe and Japan, but has also been documented in South America, South Africa, New Zealand, Australia, Thailand, Mexico, Scandinavia, and Canada (2,39). Treatment is symptomatic, including maintenance of uid and electro lyte balances, and no deaths have been reported. Diarrhea is thought to be a result of hyperphosphorylation of proteins control ling sodium secretion by intestinal cells (39), causing impaired water balance and uid loss. Whether these effects are important in human intoxications is not fully understood. Again, it is not known whether this activity poses a signicant public health threat to the seafood consumer. One study, although only tentative in its conclusions, has suggested an association be tween long-term regular shellsh consumption and digestive cancers in France (43). Other techniques, such as an in vitro phosphatase inhibition assay, immunoassays, and a variety of in vitro bioassays have been proposed and are currently in various stages of valida tion (17). Recreational harvesters, as always, should closely moni tor the local restrictions on harvesting and remember that there will probably be no visible indicators of shellsh toxicity. In this event, over 100 people became ill after eating contaminated mussels, and 3 people died. Domoic acid was not an unknown compound; it had been isolated from red macroalgae in 1958 (47) and was the active ingredient in an algal extract used as an antihelmitic in shing villages in rural Japan. Consequently, it was quite surprising to discover link between domoic acid and an outbreak of human seafood intoxication. Even more surprising was the identication of the diatom Nitzschia Copyright 2003 by Marcel Dekker, Inc. Since that time, several other species of Pseudo-nitzschia around the world have been demonstrated to produce domoic acid (48). In 1991 a die-off of numerous cormorants and pelicans occurred in Monterey Bay, California. These birds had been feeding on anchovies containing high levels of domoic acid in their guts after lter-feeding during a bloom of P. This bloom later moved up the coast and caused the toxication of razor clams and Dungeness crabs in Washing ton and Oregon. Several cases of human intoxication are thought to have resulted from the ingestion of these razor clams, although a denite connection was not made (49). In 1998, over 400 California sea lions died and numerous others displayed signs of neurological impairment in the Monterey Bay area during another bloom of P. Again, high levels of domoic acid were detected in anchovies and in the feces of the sea lions (50). Domoic acid has since been found to be seasonally widespread along the Pacic coast of the United States (51) as well as the Gulf of Mexico. Around the world, domoic acid has been reported in such diverse locales as New Zealand, Mexico, Denmark, Spain, Portugal, Scotland, Japan, and Korea. Occasionally, levels in shellsh become sufficient to stimulate bans on harvesting. Fortunately, since the initial 1987 Canadian outbreak and the suspected cases in Washington in 1991, no further human cases have been reported. The nonsensitizing nature of these currents causes a protracted inux of cations into the neurons through the receptor channels, stimulating a variety of intracellular biochemical events that lead to cell death in susceptible cells (52). Symptoms of intoxication occur within hours of ingestion and include vomiting, diarrhea, or abdominal cramps within 24 hours and potentially confusion, disorientation, memory loss, and, in serious cases, seizures, coma, and death. The memory loss involves primarily short-term memory, and in the Canadian outbreak was more prevalent in elderly patients (53). Even so, the European Community is in the process of reducing their regulatory limit to 4. However, both immunological methods and a very simple and inexpensive thin-layer chromatographic method have been reported to work very well (17). As with other recognized shellsh intoxications, avoiding toxic shellsh is paramount. Effective monitoring programs are in place and commercial products are typically safe. Azaspiracid Poisoning In November 1995, at least eight people in the Netherlands became ill after consuming cultured mussels harvested in Killary Harbor, Ireland. After further investigation, a new class of cyclic polyether shellsh toxins, known as the azaspiracids. After the initial outbreak in the Netherlands, further outbreaks in 1997 and 1998 occurred in Ireland, France, and Italy, all of which traced back to mussels harvested in Ireland. However, the cyclic polyether nature of the molecules and their seasonal occurrence suggests a dinoagellate origin (54). Unlike okadaic acid, however, azaspiracid also caused dilation of the stomach, hepa titis and fatty accumulation in the liver, and decreased lymphocyte counts in the thymus and spleen (56). While the effects of okadaic acid were transient, the deleterious effects of azaspiracids lasted for many days. These results were later conrmed in chronic exposure studies, which revealed that the stomach and intestinal damage took several months to heal (57). Even more importantly, this latter study revealed a tumorigenic property of the azaspiracids. Methylated and acylated derivatives have also been isolated and associated with azaspiracid poisoning. To date, only azaspiracids from mussels cultured in Ireland have caused human intoxication. Levels below the current regulatory limits have recently been demonstrated in mussels from northeastern England and southwestern Norway (58). Once the causative organism is identied, a wider distribution of these toxins in shellsh will likely come to light. Many regions may detect low levels of azaspiracids in shellsh, well below those required for acute intoxication. However, the tumorigenic properties identied by (56) will no doubt make this a sensitive issue. Much more research is urgently needed to better delineate appropriate safety levels for these compounds. Because these toxins occur naturally in fresh and otherwise wholesome foods, possess no visual or olfactory clues to their presence, and are impervious to typical cooking tempera tures, they can be a difficult problem for both the industry and the consumer. To combat this problem most nations have employed vigorous monitoring programs to ensure the quality and wholesomeness of their seafood. However, occasional outbreaks of poisoning occur, primarily from recreationally harvested seafood.

Important examples include the troponins (troponin I [TnI] and troponin T [TnT]) and myoglobin skin care olive oil buy 1 mg decadron mastercard. Oxygen toxicity skin care qualifications buy discount decadron 1mg, such as in the alveolar damage that can cause adult respiratory distress syndrome or as in retrolental fibroplasia (retinopathy of prematurity) acne upper lip cheap decadron 1mg mastercard, an ocular disorder ofpremature infants that leads to blindness j 3 acne prone skin discount decadron on line. Intracellular enzymes acne regimen buy discount decadron 0.5mg on-line, such as glutathione peroxidase skin care hospital in chennai 0.5mg decadron otc, catalase, or superoxide dismutase j 2. Exogenous and endogenous antioxidants, such as vitamin A, vitamin C, vitamin E, cysteine, glutathione, selenium, ceruloplasmin, or transferrin 3. Necrosis is the sum ofthe degradative and inflammatory reactions occurring after tissue death caused by injury. In pathologic specimens, fixed cells with well-preserved morphology are dead but not necrotic. Postmortem autolysis occurs after the death ofthe entire organism and is not necrosis. Heterolysis refers to cellular degradation by enzymes derived from sources extrinsic to the cell. Coagulative necrosis results most often from a sudden cutoff of blood supply to an organ (ischemia), particularly the heart and kidney. General preservation of tissue architecture is characteristic in the early stages. Nuclear changes, the morphologic hallmark of irreversible cell injury and necrosis, are characteristic. These include: J (1) Pyknosis, chromatin clumping and shrinking with increased basophilia J (2) Karyorrhexis, fragmentation of chromatin J (3) Karyolysis, fading of chromatin material J (4) Disappearance of stainable nuclei 2. Suppurative infections characterized by the formation of pus (liquefied tissue debris and neutrophils) by heterolytic mechanisms involve liquefactive necrosis. Caseous necrosis combines features of both coagulative necrosis and liquefactive necrosis. On histologic examination, caseous necrosis has an amorphous eosinophilic appearance. This type of necrosis most often affects the lower extremities or bowel and is secondalY to vascular occlusion. When characterized primarily by coagulative necrosis without liquefaction, gangrenous necrosis is called dry gangrene. This deposition of fibrin-like proteinaceous material in the arterial walls appears smudgy and acidophilic. Traumatic fat necrosis,which occurs af ter a severe injury to tissue with high fat content, such as the breast b. A tendency to involve single isolated cells or small clusters of cells within a tissue 2. Progression through a series of changes marked by a lack ofinflammatory response a. Involution and shrinkage of affected cells and cell fragments, resulting in small round eosinophilic masses often containing chromatin remnants, exemplified by Councilman bodies inviral hepatitis C. Caspases are aspartate-specific cysteine proteases that have been referred to as "major executioners" or "molecular gUillotines. The initial activating caspases are caspase-8 and caspase-9, and the terminal caspases (executioners) include caspase-3 and caspase-6 (among other proteases). The intrinsic, or mitochondrial, pathway, which is initiated by the loss of stimulation by growth factors and other adverse stimuli, results in the inactivation and loss ofbcl-2 and other antiapoptotic proteins from the inner mitochondrial membrane. Cytochrome c interacts with Apaf-l causing self-cleavage and activation of caspase-9. Downstream caspases are activated by upstream proteases and act themselves to cleave cellular targets. Cytotoxic T-cell activation is characterized by direct activation of caspases by granzyme B, a cytotoxic T-cell protease that perhaps directly activates the caspase cascade. Theentry of granzyme B into target cells is mediated by perforin, a cytotoxic T-cell protein. Additionally, complex signaling pathways involving multiple genes and gene products are the subject ofvigorous scientific investigation. Since many pathologic processes are related to either stimulation or inhibition of apoptosis. Imbalance among the uptake, utilization, and secretion of fat is the cause of fatty change, and this can result from any ofthe following mechanisms: a. Decreased mobilization of fat from cells, most often mediated by decreased production ofapoproteins required for fat transport. This term denotes a characteristic (homogeneous, glassy, eosinophilic) appearance in hematoxylin andeosin sections. Argyria (silver poisoning), which may cause a permanent gray discoloration of the skin and conjunctivae 1-3) D. This pigment is formed from tyrosine by the action of tyrosinase, synthesized in melanosomes ofmelanocytes within the epidermis, and transferred bymelanocytes to adjacent clusters of keratinocytes and also to macrophages (melanophores) in the subjacent dermis. Increased melanin pigmentation is associated with suntanning and with a wide variety of disease conditions. This pigment isa catabolic product ofthe heme moiety ofhemoglobin and, toa minor extent, myoglobin. In various pathologic conditions, bilirubin accumulates and stains the blood, sclerae, mucosae, and internal organs, producing a yellowish discoloration called jaundice. It appears in tissues as golden brow amorphous aggregates and can be positively identifed by its staining reaction (blue color) with Prussian blue dye. It exists normally in small amounts as physiologic iron stores within tissue macrophages of the bone marrow, liver, and spleen. It accumulates pathologically in tissues in excess amounts (sometimes massive) (Table 1-3). This yellowish, fat -soluble pigment is an end product ofmembrane lipid peroxidation. It commonly accumulates in elderly patients, in whom the pigment is found most often within hepatocytes and at the p. Hypercalcemia most often results from anyofthe following causes: (a) Hyperparathyroidism (b) Osteolytic tumors with resultant mobilization ofcalcium and phosphorus (c) Hypervitaminosis D (d) Excess calcium intake, such as in the milk-alkali syndrome (nephrocalcinosis and renal stones caused by milk and antacid self-therapy) 2. Dystrophic calcifcation is defined as calcification in previously damaged tissue,such as areas of old trauma, tuberculosis lesions, scarred heart valves, and atherosclerotic lesions. The cause is not hypercalcemia; typically, the serum calcium concentration is normal 1-5). Important chaperones include heat shock proteins induced by stress, one ofwhich is ubiquitin, which marks abnormal proteins for degradation. Abnormal protein transport and secretion, which is characteristic of cystic fibrosis and I)-antitrypsin deficiency Review Test Directions: Each of the numbered items or incomplete statements in this section is followed by answers or by completions of the statement. An impending myocardial infarction was heart from a 45-year-old African-American successfully averted by thrombolytic man with long-standing hypertension (clot-dissolving) therapy in a 55-year-old who died of a "stroke. Wich of the following biochemical adaptive changes is exemplifed in the events most likely occurred during the illustration A 45-year-old man with a long history of alcoholism presents with severe epigastric pain, nausea, vomiting, fever, and an increase in serum amylase. During a previous hospitalization for a similar episode, computed tomography scanning demonstrated calcifications in the pancreas. Baltimore, Lippincott In this condition, which of the following Williams & Wilkins, 2008, p. Which of the granulomatous lesions (clusters of modified following terms is most descriptive of macrophages) characteristic of this this fnding Contrast studies (passive knee extension eliciting neck pain) reveal stenosis of the right renal artery. Which of the following (e) Hyperplasia types of necrosis is most characteristic of (0) Hypertrophy abscess formation A 56-year-old man recovered from a (e) Enzymatic myocardial infarction after his myocardium (0) Fibrinoid was entirely "saved" by immediate (E) Liquefactive thrombolytic therapy. The type of necrosis shown is best described as (Reprinted with permission from Rubin R, Strayer 0, et ai. The illustration is from a liver biopsy ofa 34-year-old woman with a long history of alcoholism. A 60-year-old woman with breast cancer hepatocytes and widespread bony metastases is found to (8) Apoptosis with replacement of damaged have calcification of multiple organs. A 56-year-old man dies 24 hours after (A) Damage to organs results from the onset of substernal chest pain radiating abnormal deposition of lead. This organ enlargement is the result of an increase in size of the individual muscle cells. The patient has renal agenesis, absence ofthe kidney due to failure of organ development. The congenital lack of one kidney differs from atrophy, in which a decrease in the size of an organ results from a decrease in the mass of pre-existing cells. Unilateral renal agenesis is usually a harmless malformation, and the opposite kidney is often enlarged due to compensatory hypertrophy. Bilateral renal agenesis is incompatible with life and is of special interest since it can lead to the Potter progression (see Chapter 17). Pancreatic enzymatic fat necrosis represents autodigestion by proteolytic and lipolytic enzymes released from damaged parenchymal cells ofthe pancreas. Fatty acids liberated by the digestion offat form calcium soaps, a process referred to as saponification. Caseous necrosis occurs as part of granulomatous inflammation, typified by the lesions of tuberculosis. The decreased size is due to restriction of the blood supply, one of the causes of atrophy. If infarction is averted by immediate thrombolytic therapy, indicators of necrosis, such as karyorrhexis, pyknosis, and karyolysis, which represent irreversible changes, would not be expected. Swelling of the endoplasmic reticulum from increased cell water, one of the earliest ultrastructural changes observed in injured cells, is reversible and would be expected. Liquefactive necrosis is characteristic of ischemic injury in the central nervous system and suppurative infections that cause abscess formation (see Chapter 2). The changes inthe cerebrospinal spinal fuid characteristic of bacterial meningitis are detailed in Chapter 3. Ye llowing of the sclerae, skin, and oral mucosa are all characteristic of jaundice, the accumulation of bilirubin, the catabolic product ofthe heme moiety of hemoglobin. Jaundice can occur by diverse mechanisms: hemolytic (see Chapter 11), hepatocellular (see Chapter 16), or obstructive (see Chapter 16).