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Have you ever asked, "Why do so many people suffer from low back pain?" The answer involves a brief overview of the lumbar spine. The lumbar spine (low back) is the third major region of the spine; it is below the cervical spine and thoracic spine (Figure 1). The facet joints have been described as finger-like, and they link the vertebrae together. In addition, the facet joints help to make the spine flexible and enable you to bend forward, backward, and side to side. In the center of the spinal column is a vertical hole called the spinal canal; it contains the spinal cord.
The spinal cord and the nerves (Figure 4) are part of the central nervous system that includes the brain. Sign up to receive free updates on back pain treatments, research, and doctor-reviewed spine health information. This information is not designed to replace a physician's independent judgment about the appropriateness or risks of a procedure for a given patient. Individual primers on more than 100 skin diseases including initial evaluation, treatment options, and clinical case studies. Pediculosis, or louse infestation, is a common clinical issue that is of limited morbidity but significant public health concern, especially in school-age children.
Because lice live on clothing or hair (scalp, genital hair, or eyelashes), the primary therapeutic strategy is to identify the type of lice and to completely remove or treat the existing lice and eggs.
The eggs of head lice are highly monomorphous ovoid structures that are firmly attached to the hair shaft via a white concretion such that they are challenging to remove. First-line therapy: The first-line therapy for pediculosis depends on the type of infestation.
All of the patient’s infested clothing and bedding should be disposed of if possible.
Topical steroids and oral antihistamines may be required for days to weeks to control the pruritus. A common first-line treatment for head lice is to utilize over-the-counter permethrin 1% or pyrethrins, applied directly to the hair and scalp.
Permethrin is a synthetic pyrethroid that is less allergenic than pyrethrin (made from chrysanthemum extract). Pyrethrin can be applied to dry hair in a shampoo or mousse formulation for 10 minutes, then rinsed.
An alternative treatment schedule for topical benzyl alcohol, permethrin and pyrethrin application is on days 0, 7, and 13 to 15 (total 3 applications) given that they are not ovicidal.
Malathion 0.5% (Ovide) is a highly efficacious prescribed medication, killing 100% of lice and 98% of ova in 20 minutes. Ivermectin (Stromectol), an oral anthelminthic agent, may be given in two doses of 200 micrograms each, separated by 10 days. It is advisable that a follow-up evaluation by a physician or other health care provider be routinely scheduled at the end of the treatment period in order to assess for evidence of ongoing louse infestation and decision-making of whether additional or alternative treatments are needed. Removing nits by combing does not add to the efficacy of treatment, as nits are merely egg-casings. Pyrethrins are a potential contact allergen and should be avoided in individuals with strong sesquiterpene lactone allergy (includes chrysanthemum, feverfew, liverwort, lettuce, artichoke, ragweed, endive, echinacea, daisy, dandelion, magnolia families). Permethrin 1% cream (Nix) rinse applied to the affected area and washed off after 10 minutes. Pyrethrins (RID, Triple X, A-200) applied to the affected genital area and washed off after 10 minutes. DISCLAIMER: Use of this Website constitutes acceptance of the Derm101 terms of use and privacy policy. Growing unprecedented populations and increasing pressure on the development of new water resources have prompted a variety of measures to reclaim, recycle and reuse wastewater over the last two or three decades.
These “wastewater reuse” projects are made possible by reliability and effectiveness of wastewater treatment technologies that can turn municipal wastewater into reclaimed wastewater that can serve as a supplemental water resource in addition to meeting standards established by the Safe Water Drinking Act.
Earth is known as the “Blue Planet” because water is discovered in many places on Earth including in the atmosphere, on the surface of the Earth and within rocks below the surface.
The water cycle or hydrologic cycle describes the continuous movement of water within the hydrosphere. Many sub-cycles to the global-scale hydrologic cycle exist, involving the managed transport of water, such as an aqueduct. When considering the reuse of treated wastewater for potable purposes, critical distinctions must be made between “indirect” and “direct” potable reuse and between “unplanned” and “planned” potable reuse. The key distinction between indirect and direct potable reuse is that direct potable reuse does not make use of any environmental barrier. Indirect potable reuse is that the purified reclaimed water is pumped into a raw water supply, such as an underground aquifer or in potable water storage reservoirs, resulting in mixing, dilution and assimilation, thus providing an environmental buffer. The effective wastewater treatment technology to meet water quality requirements for wastewater reuse applications and to protect public health is a crucial element for wastewater reuse system.
The purpose of preliminary treatment is the removal of sands, solids and rags that would settle in channel and interfere with treatment processes.
Primary treatment is the second step in treatment and removes organic and inorganic matters from raw sewage by the physical processes.
The objective of disinfection in the wastewater treatment is to destroy all pathogenic microorganisms. An important issue for people to understand that there are various types of contaminants that may be in your water. Bacterium in water, also known as pathogenic organism, is a public health hazard with risk factors in nearly all regions of the world. Wastewater contains many inorganics that present known or potential health risks if consumed.
The principal issue of concern for consumer of treated wastewater is the quality of this water includes its physical, biological, chemical and radiological characteristics. A first stage in establishing wastewater reuse regulations and guidelines is wastewater reuse criteria. Regulations and guidelines are different in that regulations are legally enforceable and spell out specific figures that can be used for enforcement and administrative action, which guidelines do not have legal basic and compliance is voluntary. Public health concerns, surface and groundwater pollution, marketability of crops, and public acceptance. By far the biggest user of wastewater is agriculture throughout the entire semi-tropical and arid tropical areas of the world. Effective use of plant nutrients contained in the wastewater, such as nitrogen and phosphorus. Certain soluble constituents in the wastewater could be present at concentrations toxic to plants.
The wastewater could contain suspended solids that may plug the capillary pores in the soil as well as block nozzles in the water distribution system. Regulation, guideline and criteria have been established for the reuse of wastewater for agriculture and are normally based on several parameters, such as public health protection and concentration of components in the water.
Table 2.2 presents the details of guidelines for water quality to be used for agricultural irrigation. As indicated, salinity is the most influential parameter in determining the applicability of water for agricultural irrigation.
There are two assessments that characterize the salinity of water involving measuring total dissolved solids and electrical conductivity. The adverse impacts of salinity can be augmented by a soil with poor characteristics (such as high evapotranspiration rates and poor drainage) that can indirectly affect the crop. The sodium adsorption ratio has been developed to assess the degree to which sodium in irrigation water and provide an indicator of its potential deleterious effects on soil structure and permeability. For irrigation water containing significant values of bicarbonate, the adjusted sodium adsorption ratio is sometimes used. For general crops, the tolerance value of SAR and adjusted SAR for irrigation water is 8 to 18. However, it must be remembered that boron is essential in crop productivity at low concentrations. Note:   Relative tolerance is based on the boron concentration in irrigation water at which boron toxicity symptoms were observed when plants were grown in sand culture.
In United Nations, the Food and Agricultural organization issued guidelines for boron concentrations in irrigation water. Wastewater treatment systems are not efficient at removing boron unless some form of treatment is carried out, such as chemical precipitation. The concentrations of trace elements in treated wastewater vary with wastewater treatment processes provided and their sources. Not generally recognized as essential growth element.  Conservative limits recommended due to lack of knowledge on toxicity to plants.
Not toxic to plants in aerated soils, but can contribute to soil acidification and loss of essential phosphorus and molybdenum.
Toxic to plants at low concentrations and to livestock if forage is grown in soils with low levels of added selenium.

Toxic to many plants at widely varying concentrations; reduced toxicity at increased pH (6 or above) and in fine-textured or organic soils. The secondary treatment processes vary in their effectiveness at the removal of significant trace elements. Treated wastewater can be an important potential source of water for many industries, particularly in water-short regions. Wastewater reuse for industrial use has many potential applications, ranging from common housekeeping options to advanced technology implementation. Among the various industrial users of treated wastewater, cooling water is the greatest single application. Water quality requirements for industrial applications are related to four different issues include scaling, corrosion, biological growth and fouling, which may affect industrial process efficacy and integrity, as well as product quality. Although the entire spine is involved in everyday activities of rest and movement, the low back can be vulnerable to many pain-provoking disorders.
Most people have five bones (vertebrae) in the lumbar spine, although it is not unusual to have six.
The facet joints are located at the posterior area of the spinal column (on the back side of the spinal column). The bones that create the spinal canal serve as armor to help protect the spinal cord from injury. The nerves are the body's neural message system, and they help you move, feel, and experience sensations such as heat.
The primary concern is a hypersensitivity reaction to components of the louse saliva, which results in pruritus 4-6 weeks following the onset of the infestation. Important clues include excoriated erythematous papules (shown in this image) or maculae ceruleans (slate-blue macules) on areas of skin that come in contact with the hair. These are typically located close to the scalp (within millimeters) and may camouflage into the hair.
In general, removal of the lice and nits from the clothing (body lice) or hair (hair or pubic lice) is the priority of treatment. The remaining bedding and clothes should be washed in very hot water, dried with heat, and the seams ironed. The presence of nits on the patient’s hair represents a second lice infestation (head or pubic lice). If extensive excoriation is noted, the patient should be carefully examined or tested for bacterial superinfection and treated with systemic antibiotics if necessary. It is important to note that pyrethrin-resistance is developing and if a first attempt at treatment with pyrethrin fails, it would be prudent-if evidence of louse infestation still clearly exists-to repeat treatment with a distinct class of medications. It is available over-the-counter and applied to shampooed, non-conditioned, towel dried hair in a 1% lotion formulation (such as Nix) for 10 minutes, then rinsed. Because it is not ovicidal, application must be repeated in 9 days in order to kill newly hatched lice.
Application in a well-ventilated space is suggested, as it is a highly flammable product (78% isopropyl alcohol).
This is rarely necessary, and can be considered, but only if acceptable to the child and parent.
If two treatments with any agent are ineffective, lice resistance is confirmed and an alternative agent should be used. It is considered only for use in individuals who have failed first-line treatments, as it has been associated with neurotoxicity and lowered seizure threshold, especially in individuals who weigh less than 50 kg, are HIV-infected, or take other medications that lower seizure threshold.
In hairy men, infestation may extend down the legs, up onto the chest, and into the axillae. This site is intended for use by physicians and other healthcare providers for informational purposes only.
Regardless, I only recommend products or services I use personally and believe will be good for my readers. As part of this trend, some municipalities have commenced to reuse wastewater for non-potable water needs, such as irrigation of golf courses and parks. However, important problems remain regarding the levels of testing, monitoring and treatment needed to ensure human health when reclaimed wastewater is consumed for potable purposes. This indicates the cyclic movement of water evaporated from water surfaces, land surfaces and snow fields or evapotranspiration from land plants and animals to the atmosphere. Wastewater reuse, reclamation and recycling have become important elements of the hydrologic cycle in industrial, agricultural and urban areas. In other words, simply sending treated wastewater from a wastewater treatment facility directly to a potable water-supply distribution system or a potable source treatment facility.
Only in unusual situations do the substances in sewage significantly downgrade the value of water for other purposes.
Removal of these materials is necessary to protect the operation of subsequent treatment units.
Primary treatment includes screening to trap solid matters, comminution for removal of large solids, grit removal and sedimentation by gravity to remove suspended solids. Biological processes are engineered to provide effective microbiological metabolism of organic substrates dissolved or suspended in wastewater.2 Part of the organic matter is oxidized by the microorganisms, thereby producing carbon dioxide and other end products. In general, tertiary treatment refers to additional removal of suspended material by granular medium filtration and chemical coagulation. The major groups of pathogenic microorganisms include bacteria, viruses, amoebic cysts and protozoa. The specific contaminants leading to pollution in water involve a wide spectrum of pathogenic organisms, inorganic chemicals and organic chemical.
It is evident from the water purification attempts throughout history that human realized that drinking water could be hazardous. These contaminants include such compounds as lead, cadmium, chromium, arsenic, nitrate and sulphate. The term organic chemicals in this sense mean that they contain carbon atoms, such as chlorinated hydrocarbons, aliphatic compounds, benzenes and phenols, which mean that they are derived from petroleum.
Wastewater reuse criteria are principally directed at health and environmental protection and typically address wastewater treatment, reclaimed water quality, treatment reliability, distribution systems and use area controls.2 Wastewater reuse criteria imply an idea condition without a legal basic. In theUnited States, the Environment Protection Agency issued guidelines in 1992 that are intended to offer guidance to states, which have not developed their own regulations or guidelines. The types of wastewater reuse may be classified into the following six broad categories include agricultural and landscape irrigation, industrial reuse, groundwater recharge, recreational and environmental, non-potable urban uses and potable reuse. Agriculture receives 67 percent of total water withdrawal and account for 86 percent of consumption in 2000. These components include salinity, boron, exchangeable ions and trace metals are of particular important. These guidelines are established by the Food and Agricultural Organization in United Nation. Total dissolved solids refers to the material left in a vessel after evaporation of a filtered water sample and subsequent placed in a drying oven at a defined temperature.6 The total dissolved solids concentration relates to the conductivity of the water.
The only way to control salinity hazard is by applying more water that carries off excess salt and leaches throughout the plant’s root zone. The sources of boron in wastewater are normally from household detergents, industrial plants and sewage system where boron fertilizers are used. Boron is also one of the important micronutrients for crops to obtain a high quality and quantity crop yield.
Some management options can also be adopted to degrade the toxicity of boron in treated wastewater and improve yields.
The source of trace element is usually from industrial plant, but wastewater from residences can also have high trace element concentrations. Typically, the concentrations of trace elements in treated wastewater are in the range where negative effects are not likely to happen in short term. Can be toxic to livestock if forage is grown in soils with high levels of available molybdenum.
However, advance treatment process such as carbon adsorption and chemical coagulation can remove over 90 percent of the trace elements from the wastewater. Cadmium, copper and molybdenum can be hazardous to animals at concentration too low to affect crops. They have negative effects on plants at lower concentrations than the levels harmful to plants and animals. The quantity of water used in power generation and manufacturing processes is very large and the availability of unlimited of water was considered as a prerequisite.
The reuse of wastewater for industry can be adopted through industrial processes, internal recycling and non- industrial reuse of industrial facility effluent. All heat from various industrial processes must be removed and the most efficient coolant is water.
Simple sprains and strains from overexertion, a herniated disc from a slip and fall, degenerative disc disease or spinal stenosis from normal aging, and other disorders can cause low back pain.
Each vertebra is stacked on top of the other and between each vertebra is a gel-like cushion called an intervertebral disc.
They are often found along seam lines of clothing apparel and can also be found in bedding.

Notably, severe pruritus may result in excoriations with secondary skin infections such as impetigo. The incubation time of head louse eggs ranges from 7-12 days, depending on heat exposure and weather. An alternative strategy would be to seal infested clothing and bedding in an airtight plastic bag for a week. This can be repeated daily for 10 days if active infestation persists, as this medication is not ovicidal (does not kill eggs). It should be applied onto dry hair and allowed to dry without use of a hair dryer or other heat supply. It is no longer recommended by the American Academy of Pediatrics and has been banned in certain American states. The content of this Website is NOT a substitute for medical advice from a qualified health care provider.
In a little but increasing number of municipalities, these measures involve the use of treated wastewater to augment the general water supply. Some engineering and public health professionals oppose in principle to the reuse of wastewater for potable purposes, because standard public health philosophy and engineering practice call for using the purest source possible for drinking water.1 Others worry that existing techniques might not discover all the chemical and microbial contaminants that may be present in reclaimed wastewater.
About 71 percent of Earth’s surface is covered with water, and the oceans hold about 97 percent of all Earth’s water. Atmospheric moisture condenses into clouds and precipitated to the earth as rain, snow, hail or in some other form. Figure 1.2 illustrates an overview of the cycling of water from ground water and surface water resources to water treatment plants, industrial, irrigation, municipal application, and to wastewater reclamation and reuse facilities. This practice is rarely use because of the increased potential risk to public health and the negative public perception. This results when a water supply has a natural source that contains unintentional addition of wastewater.
In some regions, disinfection step for control pathogenic organisms sometimes follows the last treatment step. Preliminary treatment of wastewater typically includes screening, grinding, grit removal, flotation, equalization and flocculation.
In general, about one-half of suspended solids and 20 to 50 percent of the biochemical oxygen demand are removed from the wastewater by primary treatment process. The remaining organic matter in wastewater provides the materials and energy needed to sustain the microorganism community.
In other cases, advanced treatment refers to more complete removal of specific constituents, such as ammonia or nitrate removal by ion exchange or total dissolved solids removal by reverse osmosis.2 These processes essentially remove more than 99 percent of all the pollutants from wastewater, producing an almost drinking water quality. In general, disinfection can be achieved by chemical or physical method that destroys pathogens. Arsenic and lead are cumulative chemical poisons that can result in cancer, dermal lesions, peripheral neuropathies and vascular effects. Organic chemical can easily combine with human tissue which can cause damage that includes kidney, liver system problems and increased cancer risk. At the international level, the World Health Organization has developed guidelines for wastewater reuse in agriculture and aquaculture. Wastewater reuse can be employed to satisfy the water demand in various fields and contribute to the freshwater resources conservation.
In Asia and Africa, an estimated 85 to 90 percent of all the freshwater use is for agriculture. With overhead sprinkler irrigation and low humidity (<30%) sodium and chloride may be absorbed through the leaves of sensitive crops. The total dissolved solid can be calculated by multiplying conductivity by a factor, but the factor is not a constant. When sodium concentrations are high, the soil permeability is reduced and the soil structure is affected. These management options are engineered to provide additional nitrogen to maximize fertility of the soil.
Trace elements normally occur in treated wastewater but at very low concentrations, usually less than a few milligrams per liter with most less than 100 micrograms per liter.
However, long term application of treated wastewater containing trace elements may lead to accumulation of trace elements in soil and may potentially result in groundwater contamination and plant toxicity. The water can be a once-through recirculating cooling system or cascading use of cooling water in other applications.
Human body (but not head) lice are rarely associated with the spread of relapsing fever (Borrelia recurrentis), epidemic typhus (Rickettsia prowazekii), and trench fever (Bartonella quintana). When empty, these egg casings are referred to as nits and are typically lighter in color and easier to visualize. It is important to note that many conditioners or conditioning shampoos impair the efficacy of topical permethrin. If live lice persist, it should be reapplied in 9 days; however, malathion is highly effective after a single application. A major catalyst for the development of wastewater reuse, recycling and reclamation has been the need to provide alternative water resources to achieve water quantity requirement for industry, irrigation, urban potable and non-potable water applications.
Several guidelines pertaining to potable reuse of wastewater have been issued, but these guidelines offer conflicting guidance on whether potable is adoptable and, when it is adoptable, what safeguards should be in place. Once the precipitated water has fallen to Earth, it may percolate through soil strata to form groundwater aquifers or runs off into streams, lakes, ponds and the sea.
Planned indirect potable reuse is common practice to artificially recharge water supply sources with reclaimed water derived from treated wastewater. In addition, there are many toxic and carcinogenic substances present in wastewater at levels that may or may not be adequate to cause disease. Treatment equipment such as bar screens, comminutors and grit chambers are adopted as the wastewater first enters a wastewater treatment plant. Nutrients, pathogenic organisms, trace elements and potentially toxic organic compounds that are associated with solids in wastewater can also be removed by primary treatment processes. Secondary treatment systems can remove suspended solids and up to 95 percent of the biochemical oxygen demand entering the process, as well as certain organic compounds and significant amount of heavy metals. Chemical methods are based on the addition of a strong acid, alcohol or an oxidizing chemical (such as chlorine, ozone, hydrogen peroxide or bromine).
The World Health Organization guidelines are adopted throughout the world and provide all countries with the necessary information to set their own wastewater reuse regulations or guidelines. Table 2.3 presents general guidelines as to the salinity hazard, total dissolved solids (TDS) and electrical conductivity.
When calcium is normally the predominant exchangeable cation in soil, the soil tends to have a granular structure which is easily worked and readily permeable. Table 2.5 presents the detailed guidelines for the allowable concentration of boron in treated wastewater for agricultural irrigation.
Some trace elements are essential for plant and animal growth at low concentrations, but all can exhibit plant toxicity at elevated concentration.
The range and recommended maximum concentrations of the trace elements in treated wastewater for agricultural irrigation are presented in Table 2.6. The ligaments and tendons help to stabilize the spine and guard against excessive movement in any one direction. Important diagnostic considerations are hair shaft casts (circumferential keratinous bands that easily slide up and down the hair shaft), seborrheic dermatitis (loose, greasy scale that is very loosely adherent to hair, if at all), and a superficial fungal infection of the hair shaft. The benefits coupled with reusing treated wastewater for supplemental applications prior to disposal or discharge include environmental protection, preservation of high quality water resources and economic advantages.
In grit chambers, the velocity of wastewater through the chamber is retained sufficiently high, so as to avoid the settling of organic solids.
Alternatively, physical methods might include heating, incineration and irradiation with ultraviolet radiation. Most beef and milk products are unaffected by livestock ingestion of cadmium as it is stored in the kidneys and liver of the animal rather than the muscle tissues or fat. Though not considered a serious threat to human health, louse infestation is contagious and can become a public health concern, especially when infestations affect school-age children, their caretakers, and household members.
It is important to note that the primary mode of transmission of hair lice is through direct contact with the head of an affected individual, though rarely may also occur through fomites such as hats and hair brushes.
The reason that indirect potable reuse is not considered to cause a health risk is that the treated wastewater benefits from natural treatment from storage in surface water and groundwater aquifer before abstraction to ensure good water quality. Comminutors are sometimes used to supplement course screening and serve to decrease the size of particles so that they will be removed and disposed of in a landfill.
Disinfection is frequently combined with treatment plant design, but not effectively practiced, because of the reduced effectiveness of ultraviolet radiation or the high cost of chlorine where the water is not sufficiently clear or free of particles.
Parasitic diseases, such as Schistosomiasis, Ascariasis and Taeniasis, are also transmitted via water.
It is important to note that the patterns of treatment-resistance especially to over-the-counter products have emerged, and thus the therapeutic strategies have shifted in recent years.

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