Are there steps physicians can take to reduce the risk of CIN?

Yes. SCAI's Catheterization Laboratory Standards Committee has analyzed the available data about CIN and issued recommendations for the prevention of CIN at each stage in the treatment of patients who are undergoing interventional procedures that involve the use of contrast media. 

The first step is to assess a patient's kidney function. SCAI recommends that physicians assess kidney function using estimated glomerular filtration rate, or eGFR, which takes into account the patient's age, race, and other factors. The eGFR is most accurate assessment of kidney function currently available. 

Another important precaution for preventing CIN is to ensure that the patient is adequately hydrated before, during, and after interventional procedures that involve the use of contrast dyes. Patients who are at increased risk for CIN should come into the hospital far enough in advance of the procedure so that they can be given appropriate intravenous hydration. 

Patients should consult with their physicians to determine whether to discontinue taking non-steroidal anti-inflammatory agents (NSAIDS) 24-48 hours before a procedure. These medications include ibuprofen and Naprosyn, and are commonly taken for headaches, backaches, and arthritis pain. NSAIDS may cause a decrease in blood flow to the kidneys and, when combined with contrast media, are more likely to interfere with kidney function in some patients. 

SCAI recommends that physicians use low osmolar and iso-osmolar contrast agents instead of high-osmolar agents in patients at increased risk for CIN. Osmolarity refers to the number of ion particles in the blood. A low-osmolar agent is thinner than a higher osmolar agent and is considered to be safer because it is less likely to interfere with blood flow to the kidneys. Iso-osmolar contrast agents are even thinner. 

Patients at increased risk for CIN should be monitored closely after their procedure for any signs of kidney failure. In patients at increased risk for CIN, a serum creatinine test should be done during follow-up to provide assess kidney function. This test measures the amount of creatinine, an amino acid excreted by the kidneys, in a person's blood work. 

What causes back pain during pregnancy?

Back pain during pregnancy is related to a number of factors. Some women begin to experience lower back pain with the onset of pregnancy.  Women who are most at risk for back pain are those who are overweight or had back pain prior to pregnancy. Here is a list of potential causes of back pain or discomfort during pregnancy:

• Increase of hormones – hormones released during pregnancy allow ligaments in the pelvic area to soften and the joints to become looser in preparation for the birthing process of your baby; this shift in joints and loosening of ligaments may affect the support your back normally experiences
• Center of gravity – your center of gravity will gradually move forward as your uterus and baby grow, which causes your posture to change
• Additional weight – your developing pregnancy and baby create additional weight that your back must support
• Posture or position – poor posture, excessive standing, and bending over can trigger or escalate the pain you experience in your back
• Stress – stress usually finds the weak spot in the body, and because of the changes in your pelvic area, you may experience an increase in back pain during stressful periods of your pregnancy

Prevention of back pain

Good back care can greatly reduce your risk of getting low back pain. To look after your back, make sure you:

• take regular exercise - walking and swimming are particularly beneficial
• try to keep your stress levels to a minimum
• bend from your knees and hips, not your back
• maintain good posture - keep your shoulders back and don't slouch

Causes and Risk Factors for Chronic Back Pain

In addition, the exact cause of pain may be difficult to identify since it can originate in soft tissue, bone, discs or nerves. People who smoke, work at jobs that require repetitive or heavy lifting or involve vibration from vehicles or industrial machinery are more likely to develop low back pain. Certain sports, such as cross-country skiing, or driving a vehicle for a long time can also cause back pain.

Diseases such as spinal osteoarthritis, spondylitis and compression fractures can also cause pain. Some of these diseases are more prevalent in the elderly, consequently older people are at higher risk for back pain.

What can a spine surgeon do for my back or leg pain?

Whether or not to undergo surgery is a decision that you and your surgeon and/or physiatrist will make together, based on your symptoms and your overall health. Although spine surgery can be an extensive procedure, most patients, even the elderly, are medically capable of tolerating the procedure.

If you are severely disabled by your back or leg symptoms, and non-operative treatment has not decreased your symptoms, then surgery may be a reasonable option. The choice of a specific surgical technique depends on the exact cause of your pain and your surgeon’s preference. Regardless of the surgical approach that is chosen, if decompression (making room for the nerves) is not adequate, relief of symptoms may be incomplete or the problem may recur following a short period of clinical improvement.

• Laminectomy: A standard decompressive procedure to enlarge the space available for your nerves. This involves a midline incision over the involved levels, dissection down to the spinous processes, and removal or “unroofing” of parts of your bony vertebrae (spinous processes, laminae, and ligamentum flava) to make room for the nerves in the spinal canal. This procedure is often performed across multiple vertebral levels, since canal stenosis rarely occurs in an isolated fashion. Removal of other bony prominences such as facet joints (oftentimes enlarged because of osteoarthritis) may be necessary to adequately decompress the nerves.
• Hemilaminectomy: An alternative to the basic laminectomy, with slightly less risk of destabilizing the spine because only half of the structure is removed.
• Laminotomy: “Windows” or fenestrations are created by removing the superior aspect of the inferior lamina and the inferior aspect of the superior lamina at the involved levels. Proponents of this approach believe that sparing the interspinous ligaments and preserving spinous processes minimizes the risk of postoperative instability.
• Medial Facetectomy: If you have osteoarthritis in your spine, then your facet joints might be enlarged with osteophytes. Sometimes, in order to adequately decompress your nerves, it may be necessary to remove part of the medial facets. However, this additional procedure has the potential of creating instability in your spine, which may then require instrumentation and fusion.
• Laminoplasty: Involves the en bloc removal and loose reattachment of the posterior vertebral arches.
• Vertebroplasty: Used in cases of back pain caused by compression fractures. Percutaneous vertebroplasty involves injecting acrylic cement into the collapsed vertebra to stabilize and strengthen the fracture and vertebral body. This procedure does not restore the shape or height of the compressed vertebra.
• Kyphoplasty: Used in cases of back pain caused by compression fracture. First, the compressed vertebral body is expanded by a high-pressure balloon, then acrylic cement is injected into the cavity to restore height to the collapsed vertebra.

Manipulation Treatment for Back pain

Manipulation is a technique used by physical therapists, chiropractors, osteopaths, massage therapists, and others to treat acute and chronic back pain. It involves moving a joint (spinal column) beyond the normal range of voluntary movement.

In clinical trials of people who had back pain for more than 4 weeks, manipulation was found to be safe and as effective as "conventional" treatments (eg, pain medication, rest, exercise) . The optimal number of manipulations is not known; most clinical trials used two treatments per week for two to three weeks.

Lower Back Pain Surgery Treatment

Only a small minority

of people with low back pain will require surgery. Surgery is often necessary if there is evidence of cauda equina syndrome (problems with the nerves at the base of the spinal cord), another serious back condition like a tumor or infection, or severe weakness due to spinal stenosis or compression of a nerve root. 

Surgery may also be considered for people with persistent radiculopathy due to herniated disc or spinal stenosis that has not responded to other (non-surgical) therapies. There is controversy about whether surgery is beneficial for people with degenerative disc disease alone.

Referral to an orthopedic surgeon or neurosurgeon is recommended under the following circumstances:

Increasing neurologic problems (measurable weakness)
Loss of sensation (eg, numbness) or bladder and bowel symptoms
Failure to improve after four to six weeks of non-surgical management, with persistent and severe sciatica and evidence of nerve root involvement

Acupuncture for the treatment of back pain

Reviews of clinical studies have found that acupuncture may be effective for low back pain. In addition, acupuncturists frequently report success in treating low back pain, and the National Institutes of Health recommend acupuncture as a reasonable treatment option. An acupuncturist may use a comprehensive approach including specialized massage, warming herbal oils, and patient education.

Treating low back pain with acupuncture can be complex because many meridians (including the kidney, bladder, liver, and gallbladder) affect this area of the body. Treatment of the painful areas and related sore points is often done as well, with needles or moxibustion (burning the herb mugwort over specific acupuncture points).

A study using acupuncture to treat 1,162 patients with a history of chronic low back pain found that at 6 months, low back pain was better after acupuncture treatment -- almost twice as better than from conventional therapy. Patients had ten 30-minute acupuncture sessions, generally two sessions per week.

Analgesics for the treatment of BACK PAIN

 Analgesics are among the most commonly used drugs for many forms of arthritis and other causes of back pain. Unlike NSAIDs, which target both, pain and inflammation, analgesics are designed purely for pain relief. For that reason, they may be safe for people who are unable to take NSAIDs due to allergies or stomach problems, for example. When taken as directed, analgesics also are an appropriate, and possibly safer, choice for pain not accompanied by inflammation.

Herbs for the treatment of back pain

Herbs are generally available as standardized, dried extracts (pills, capsules, or tablets), teas, or tinctures/liquid extracts (alcohol extraction, unless otherwise noted). Mix liquid extracts with favorite beverage. Dose for teas is 1 - 2 heaping teaspoonfuls/cup water steeped for 10 - 15 minutes (roots need longer).

• Turmeric (Curcuma longa) standardized extract, 300 mg three times a day, for pain and inflammation. Turmeric is sometimes combined with bromelain because it makes the effects of bromelain stronger. Turmeric can increase the risk of bleeding, especially for people who take blood-thinning medication. Ask your doctor before taking turmeric.
• Devil's claw (Harpagophytum procumbens) standardized extract, 100 - 200 mg one to two times daily. Devil' s claw has been used traditionally to relieve pain. One study found that more than 50% of people with osteoarthritis of the knee or hip or low back pain who took devil' s claw reported less pain and better mobility after 8 weeks. Devil' s claw may increase the risk of bleeding and interact with diabetes medications, so tell your health care provider before taking it if you also take blood-thinning medication or if you have diabetes. Devil's claw can affect the heart and may not be right for people with certain heart problems. It can also potentially be problematic for people with gallstones.
• Willow bark (Salix alba) standardized extract, 500 mg up to three times daily, to relieve pain. Willow acts similar to aspirin. Do not take white willow if you are also taking aspirin or blood-thinning medications. Check with your health care provider if you are allergic to aspirin or salicylates before taking white willow. Do not give Willow should to children under the age of 18.
• Capsaicin (Capsicum frutescens) cream, applied to the skin (topically). Capsaicin is the main component in hot chili peppers (also known as cayenne). Applied to the skin, it is believed to temporarily reduce amounts of “substance P,” a chemical that contributes to inflammation and pain. One found a topical capsaicin cream relieved pain better than placebo in 320 people with low back pain. Pain reduction generally starts 3 - 7 days after applying the capsaicin cream to the skin.

Where to go for BACK PAIN treatment

When back pain goes on and on, many people go to see a primary-care doctor. While this visit may help rule out any serious underlying disease, a surprising number of the lower-back-pain sufferers we surveyed said they were disappointed with what the doctor could do to help. Although many of our respondents who saw a primary-care doctor left dissatisfied, doctors can write prescriptions and give referrals for hands-on treatments that might be covered by health insurance.

Corticosteroids for treating Back Pain

 These quick-acting drugs, similar to the cortisone made by your own body, are used to control inflammation. If inflammation is due to a systemic inflammatory disease, such as polymyalgia rheumatica or rheumatoid arthritis in the back, your doctor may prescribe oral corticosteroids. If inflammation is limited to an inflamed joint in the spine, your doctor may inject a corticosteroid preparation directly into the inflamed joint.

If Your Back Pain Lasts a Long Time

In most cases, treatment back pain is not necessary, because you’ve simply pulled a muscle, strained your back, or otherwise done temporary, short term damage to your back. That sort of back pain will usually disappear all on it’s own, without the necessity for treatment back pain.

However, if your back pain is not lessening after a few days, or if it seems to be getting worse, rather than better, then it’s probably time to visit your doctor. Strains, sprains and other minor injuries should get better with time. Not worse.

Spinal injections:Back pain treatment

Spinal injections are generally not considered an appropriate treatment for acute, self-limited low back pain. There are several injection options for persistent or recurrent pain, including epidural steroid, facet joint and trigger point injections, which can be determined following a comprehensive medical evaluation.

How can you treat back pain during pregnancy?

There are a number of things you can do to treat back pain during pregnancy. Some of the steps you take to avoid back pain may also be used to treat current back pain. Here are some other common interventions:

• Ice or heat
• Braces or support devices
• Sleep on your left side and use a support pillow under your knees
• Medications used to treat inflammation
• Use a licensed health care professional such as a chiropractor or massage therapist

What causes low back pain?

The exact source of acute low back pain is often difficult to identify. In fact, there are numerous possible pain producers including muscles, soft connective tissue, ligaments, joint capsules and cartilage, and blood vessels. These tissues may be pulled, strained, stretched or sprained. Additionally, annular tears (small tears that occur in the outer layer of the intervertebral disc) can initiate severe pain. Even if the actual tissue damage is minor, and likely to repair quickly, the pain experienced may be quite severe.

No matter which tissue is initially irritated, a cascade of events occurs which contributes to the pain experience. Numerous chemical substances are released in response to tissue irritation. These substances “stimulate” the surrounding pain sensitive nerve fibers, resulting in the sensation of pain. Some of these chemicals trigger the process of inflammation, or swelling, which also contributes to pain. The chemicals associated with this inflammatory process feed back more signals which perpetuate the process of swelling. The inflammation attributable to this cycle of events may persist for days to weeks.

Muscular tension (spasm) in the surrounding tissues may occur resulting in a “ trunk shift” (the body tilts to one side more than the other) due to muscular imbalance. Additionally, a relative inhibition or lack of the usual blood supply to the affected area may occur so that nutrients and oxygen are not optimally delivered and removal of irritating byproducts of inflammation is impaired.

Treat with cold and heat for Back Pain

First, apply an ice pack for five minutes, then take it off for five minutes. Repeat for up to half an hour. “The cycle of cooling tricks your body into increasing blood flow to the sore muscle, which promotes healing.” Meehta says. The next day, you can use a heating pad or a hot towel, which will help to relax any remaining tightness. 

Tips to prevent back pain

Almost anything you do throughout the day can bring on back pain. The most common causes are manual handling and lifting, bending and twisting. In large studies, sitting and standing posture have not been shown to be significant risk factors. "I would advocate that we move away from dogmatic teaching about 'right' and 'wrong' posture and encourage people to listen to their body," says Professor Maher. "People soon work out what works for them with regard to posture."

Thankfully, there are some simple preventive measures you can take to lower your chances of hurting your back.

• Bend your legs, not your back when lifting.
• Maintain a healthy lifestyle. Eat well, stop smoking and exercise daily. Studies have shown a holistic approach is best when it comes to looking after your back.
• Chill out - stress can actually increase the risk of back pain.

Sciatica Back Pain

Representing about four per cent of back pain cases, this is where a damaged spinal nerve (usually caused by a disc protruding onto it - a herniation or slipped disc) leads to back pain and numbness, and pain and pins and needles down the leg. Patients are managed with the same methods as those used for mechanical back pain. Surgery is an option, but Professor Maher says it's usually avoided, as the long-term results aresimilar to other treatments.

PURCHASE DINING DISCOUNTS

In desperate need of a romantic date night but not another charge on your credit card? Get back in the mood by heading to Groupon.com or Restaurant.com for major savings at tons of great restaurants (read: not just Applebee’s) in your ’hood. Groupon.com, which covers over 160 cities in the U.S. and Canada alone, offers daily discounts at restaurants, while Restaurant.com offers discounted gift cards to restaurants. Even better: The already-discounted cards go on sale frequently, so you could land a gift card for just $1 (no joke).

Potential Radiation Effects on the Fetus by Gestational Age and Radiation Exposure

Potential Radiation Effects on the Fetus by Gestational Age and Radiation Exposure

Deer Creek Canyon in Grand Canyon National Park

Deer Creek Canyon in Grand Canyon National Park, Arizona

a.

Future Radiation Protection During Cardiac Catheterization

Cardiac catheterization, whether for diagnostic procedures or cardiac interventions, will continue to be performed using ionizing radiation as a result of excellent temporal and spatial resolution afforded by fluoroscopy. It is probable that future improvements in detector sensitivity coupled with improved digitalization of the images will mean that radiation doses are reduced. It is apparent from the observations made concerning radiation doses following the introduction of flat-bed scanners that optimization of pulse frequency, filter settings, AEC management and collimation are also important when new technology is used.


Optimization of the system settings should be combined with the continued education of operators and ancillary staff.[12,65] The increasing complexity of digital imaging systems may distract staff from the importance of operator-dependent factors in controlling the levels of radiation during cardiac catheterization. In spite of the significant improvements in image quality and potential for radiation dose-lowering from digitalization and flat-bed panel systems, operator factors remain perhaps the most important determinants of radiation exposure during cardiac catheterization.

Cardiac CT Dose

Cardiac CT is emerging as an important tool for the diagnosis and monitoring of heart disease. The incidence of heart disease in the United States is already quite high and is expected to increase as the “baby boomer” segment of the population ages. To use complex multiple-row detector CT scanners most efficiently for cardiac examinations, it is important to understand many of the technical components. In addition, radiation dose for cardiac CT studies is fairly high and demands constant vigilance.

Cardiac CT techniques are generally similar to those used for routine chest CT—with a few important exceptions. Although the tube potential (measured in kilovolts) and current (measured in milliamperes) are often similar to those used for a routine chest CT study, the rotation speed is generally the fastest that can be achieved by the scanner model, and the pitch value used is often much lower than that used in routine chest examinations (typically 0.2–0.4). The use of extremely low pitch values can cause some alarm with respect to radiation dose values. However, the scan extent (start-to-stop distance for the image acquisition) is generally limited (usually 12 cm), which results in a dose range that is near accepted values for similar CT examinations of the torso.

Reduction of Cardiac CT Dose

The dose of radiation delivered during a cardiac CT examination can be decreased by implementing features such as tube current modulation, cardiac phase–specific scanning, and increased pitch.
For instance, all scanners are designed so that the x-ray tube current can be modulated, or varied, while the gantry spins around the patient. The tube current thus can be decreased when the beam crosses areas of the body with less tissue or lower tissue density, thereby lowering the total overall dose of radiation needed (9). In general CT examinations, dose reductions on the order of 20%–40% have been achieved with these approaches (10–12).

A dose-reduction approach specific to cardiac CT is to decrease the x-ray tube current during phases of the cardiac cycle that are expected to contain fairly large amounts of motion. Images acquired during these phases are expected to be of lower quality and of less value for interpretation; thus, the radiologist may choose that they not be captured for use in image reconstruction. Dose reductions of up to 50% have been achieved with this feature (13). This option may or may not be successful at individual facilities; many radiologists appear to demand images from all cardiac cycles to review regardless of their temporal resolution quality.

A third means of reducing the effective dose is to use a higher pitch value. This method is particularly used for selective patients with higher-than-normal heart rates, as with the new dual x-ray tube CT scanner discussed earlier (14). The overall dose of radiation delivered can also be substantially decreased with this method.

Combining two or more of these dose reduction options during a cardiac CT study may result in even greater decreases in the dose of radiation delivered.

Aggstein Castle - Austria

Aggstein Castle ruins are situated on a steep cliff on the right bank of the Danube. Built around 1100 by Manegold von Aggstein, it has been extended in the 15th century. The ruins are a nice hiking goal with a good view over the Danube valley.

Aggstein Castle is one of the most attractive castles in the region of Wachau. Although surrounded by ruins, Aggstein Castle broadcasts real dignity and medieval splendor. The castle was built on a cliff on the right bank of the Danube. In Austria this crumbling palace is known as Burgruine Aggstein.

Aggstein Castle, along with The monastery of Melk offer a great panorama of the city Durnstein. Along the Danube near Durnstein are the most popular traits with which one can connect to the beautiful area of the Wachau.

Which debts should I pay off first?

Some debts are more urgent than others. These are known as priority debts. You could face serious consequences for not paying back these debts. They include:

• mortgage or rent arrears
• gas and electricity arrears
• council tax arrears

If you've got some money to pay off your debts, you should pay back priority debts first. 

After that you can deal with any less urgent debts such as credit card debts, overdrafts and other loans. These types of debts are known as non-priority debts. 

If you are dealing with non-priority debts, reduce your most costly ones first. These are the ones with the highest interest rates or late-payment fees.

Bankruptcy

If you file for bankruptcy, you may be able to eliminate most or all of your debts very quickly (in a Chapter 7 Plan) or over five years or less (in a Chapter 13 Plan). If you are being threatened with debt collection lawsuits, if your income has been to reduced to the point where you can't make your payments, or if you are simply feeling overwhelmed with your debt, it's a good idea to talk with a bankruptcy attorney to find out whether it may provide the relief you need.

Bankruptcy may work for you if: You have significant debts that can be discharged (eliminated), and your income does not prevent you from doing that.

To make it work: Talk with a qualified bankruptcy attorney, one whose practice is largely devoted to bankruptcy and helping consumers in debt. Ask for referrals from financial professionals you trust, or visit NACBA.org. When you do meet with an attorney, bring all the documentation he or she instructs you to bring, and be completely honest about your situation. And don't wait until you've been sued or you raided your retirement accounts to talk to an attorney.

Ask for a lower interest rate

Grab a bill from any account charging you more than 14% interest. Dial the toll-free number on the bill and ask to have your rate reduced -- say, to 11%. Tell them that you'd really like to stay with them out of customer loyalty (embellish according to your acting skills), but that you have received offers for much-lower-rate cards. Expect to be made very uncomfortable, but stand firm and remember that, to them, you are both a customer and a profit center. You also stand to save a bundle. The more calls you make, the more persuasive you'll become.

DON’T PAY FULL PRICE AT THE THEATER

There’s nothing better than spending a snowy Sunday at the movies, but ticket prices (plus those $5 Cokes and $7 popcorns) are enough to make you as homicidal as Patrick Bateman in American Psycho. Before you go and try to feed a kitten to an ATM, hit up Costco or Sam’s Club, where you can buy discounted movie tickets to major theater chains like AMC. (You can also ask your employer if it offers discounts at certain theaters––many do.) Don’t have a membership? Instead of dinner and a movie, go for a matinee followed by the early-bird special.

Save for the Unexpected to Get Out of Debt & Stay Out of Debt

Building up a savings account may seem like a daunting task, especially when trying to eliminate debt at the same time. However, having savings is the one true trick for getting out of debt! Some tips to jump start a savings account include:

• Save unexpected funds, such as tax refunds, gift money or bonuses from work, in a separate account.
• If you are paid bi–weekly, you will have 2 extra pay cheques during the year – add them to your savings account.
• If you receive a pay increase, continue your budget as if you were still earning the lower amount.
• Make savings automatic – ask your employer or financial institution to direct deposit a set amount to your savings account each pay day.

Pay off the debt with the highest interest charge first

As credit cards generally charge higher interest rates, it is best to pay the bills in full each month. If you have difficulty paying your credit card bill in full, then pay as much as you can. At the same time, cut back on your credit card spending. The faster you reduce your outstanding balance, the less interest you will have to pay. 

If you have multiple debts, consider refinancing or consolidating your debts by transferring all the outstanding balances to a package offering a lower rate of interest. Before you do that, however, make sure you find out whether the lower rates apply for a limited period only. You should also find out what other terms and conditions may apply (e.g. fees and charges, fixed or flexible monthly repayment amounts).

Always pay more than the minimum payment toward your debt

Always pay more than the minimum payment toward your debt. If you only pay minimum payments, you will be old and gray before you pay off a the debt. Here is a calculator that shows the true cost of paying minimum. For example, if you only pay the minimum payment on a credit card loan of just $1000, at an APR of 18%, then it will take you around 13 years to pay off that debt. In that time you would have paid $1,115.41 in interest. That is more than the principal borrowed! Imagine how much worse it is with larger loans. So always try to make more than the minimum payments if you are serious about getting rid of debt.

How to improve credit scores to qualify for a loan

Here are a few ways people with a negative credit history can raise their credit scores and ultimately obtain financing for a new mortgage loan:

• Improve payment history by making payments on time
• Do not open new lines of credit Use credit cards sparingly, and without overextending credit lines
• Make payments in full Have up to four different kinds of credit accounts
• Show evidence of steady employment for a period of one to two years
• Come up with a budget plan and stick to it
• Build up savings

Insider's tip: Credit experts advise not spending more than 25 percent of your available credit on any credit card account. If you have a $1,000 maximum in a given account, the balance should not be more than $250-$300. Better yet, wipe the slate clean and carry no balance whatsoever.  

Home equity loan

A type of loan where the debtor applies the equity in their house as collateral is called a home equity loan. This loan is typically given in a lump sum with a fixed interest rate. Many people use it to finance large expenses such as home renovations, medical fees or higher education. A home equity loan makes a lien against the debtor's house, thus reducing actual home equity. Having an excellent credit history is one of the first steps that can qualify you for a home equity loan (HEL).
HELs are normally referred to as second mortgages, because like a conventional mortgage, they are secured against the worth of the home. Home equity loans are often used for a shorter loan term than first mortgages. To determine whether you can deduct home equity loan interest from your income taxes, consult a tax authority.

Apply for a loan

The application process is the easy part -- provided you've gathered documents necessary to prove claims you make on the application.
The application will ask for information about your job tenure, employment stability, income, your assets (property, cars, bank accounts and investments) and your liabilities (auto loans, installment loans, mortgages, credit-card debt, household expenses and others).
The lender will run your credit report to look at your FICO scores, which are very important when it comes to rates and terms you will be offered. You will also likely have to supply additional documentation, including paycheck stubs, bank account statements, tax returns, investment earnings reports, rental agreements, divorce decrees, proof of insurance, among other information. If the lender deems you creditworthy, it will likely hire a professional appraiser to make sure the value of the home you want to buy is worth your purchase price.

Scrutinize your expenses honestly

To save the bigger picture you have to delve in to the smallest details. Careless money spent on a cappuccino regularly could have added a few extra bucks to your pocket at the end of the month. Distinguish between needs and wants. In reality there are few things that we really need, all the rest results from our own desires. This is not advice to make you stingy but to be smart. Know where to draw the line and always spend within your limits.

Top 10 money mishaps

1. Not having a grip on your expenses: You need to figure out your spending habits and start keeping track of where your money goes. Watch impulse buying — it can get you into trouble.
2. Not paying off high-cost, high-interest debts first: Think about consolidating your debts.
3. Not having an emergency fund: Try to save three to six months worth of living expenses to get you through a financial crisis.
4. Over-extending your credit cards: Be careful not to get into debt, especially when using credit cards. Pay off the balance every month to avoid interest charges.
5. Not protecting yourself and your family with adequate life, medical, property and disability insurance: See an insurance specialist to make sure you’re properly covered.
6. Not having an up-to-date will: Everybody should have a will — especially if you have dependents. If it’s more than three years old, review it; the law or your personal circumstances may have changed.
7. Poor investing practices: Making all of your investments through one vehicle can be a devastating error — it’s better to diversify your portfolio.
8. Not planning for retirement early enough: Set up a retirement savings plan as early as possible and try to contribute what you can afford.
9. Not saving early for children’s education: Start saving by opening a Registered Education Savings Plan (RESP). The federal government adds to your contributions each year to help your child’s plan grow.
10. Not having an understanding of tax benefits: Take full advantage of all of the tax credits and deductions available

Manage your debt

List what's owed on each debt and when payments are due. "It's your job as a couple to keep on top of it," says Paul Lermitte, a certified financial planner with Integrated Planning Group/Assante Financial in Vancouver. "If one of you is in charge of paying the bills, the other should at least review what's being done or try sharing the job. It's one way of diffusing arguments about money." He also advises automatic payments: that way everything is paid and paid on time.

And you need to determine just how much debt you can carry. Once you've mapped out what's coming in and going out, it's easy to see what's left. For a mortgage, Lermitte recommends a 20-year amortization as opposed to the more traditional 25. "The first five years are mostly interest," he says. By choosing a shorter amortization you will shave thousands of dollars off your interest costs.

"The real problem area for most couples is credit-card debt," he says. It's easy to understand -- rates vary from 9.9 to 28.8 per cent. If you owe $2,300 at 18.4 per cent, for example, and make only the minimum payments, you'll end up paying more than twice that by the time you make the last payment -- and it will take 18 years. "The day you find you can't pay your cards off on a monthly basis, cut them up," he says.

Fonthill Castle - Doylestown- Pennsylvania

Fonthill Castle, Doylestown, Pennsylvania
A poured-concrete castle in the Philadelphia 'burbs is certainly odd, but odder still are the rumored hauntings at Fonthill: It has been said that the ghost of a housekeeper still wanders the estate. For more earthly visitors, Fonthill, now part of the Mercer Museum, welcomes guests to peruse its former owner's elaborate collection of art and artifacts.

Swallow's Nest

The Swallow's Nest is a decorative castle near Yalta on the Crimean peninsula in southern Ukraine.

The "Swallow's Nest Castle" stands on the Rock of Aurora,40 meters (130 feet) above the Black Sea. It is known that it was built by a retired general, a participant of the Russian-Turkish war and he was a really romantic person, because only a romantic could have the strength to build a castle as Swallow's Nest, called "Castle of Love”. It was built in the spirit of chivalrous times. Its house is decorated with towers, steeples, balconies, windows of Gothic forms and battlements. 

Children are more vulnerable for CELL PHONE RADIATION

According to two studies completed in France and Germany, small children absorb twice as much radiation when using cell phones as adults do, due to their small ears, and thinner skin and skulls.

The French report, completed for TELECOM ParisTech by Dr. Joe Wiart, found young children can have radiation exposures twice that of adults, possibly even higher.

The second study, conducted by Niels Kuster, director of the IT’IS Foundation, had the same results. Completed for the German Federal Office of Radiation Protection (BfS), the study concluded that children’s eyes and bone marrow received more exposure.

The studies' findings support a 1996 study by Prof. Om Gandhi at the University of Utah, which found that radiation penetrates the brain of a child 4.2 times faster than an adult brain, and a child's eye more than 12 times faster.

Switch to Unlimited Texts to save money

Are you a text-a-holic? Have you monitored just how much texting you during a week? A month? A day? If you are anything like me, you remember the days when people would come pick you up and knock on the door. This evolved into a quick phone call to say, “Hey, I am outside.” Nowadays, it is a simple text: “I’m here.” But how many “I’m here” texts do you send out?

Switching to an unlimited text messaging package can save you money in the long run. If you go over your monthly text plan, you are likely being charged between 5 and 15 cents per text message. And you will be charged double for group texts or picture messages. This can really add up over time. Switch to an unlimited plan and send as many “I’m here” texts as you like.

Sometimes, spend more the first time

Sometimes, spend more the first time. Sounds counter-intuitive, doesn’t it? It’s not. If you buy the cheapo product to save cash (windshield wipers, for example), you’ll likely end up paying more in the end, as you’ll have to replace them sooner than you would had you bought the better-quality product to begin with. That’s not to say you should buy the most expensive product in the store—the top brand will typically have lower-cost models as well, which is what you’re looking for. The quality will be much better than the “discount” option, and the price is generally pretty reasonable.

Do an income and expense summary

Summarize your annual income, your fixed expenses, and your optional expenditures. Use your tax returns, your checkbook, and your charge card statements to get your figures as accurate as possible.

A two-year summary is best - last year and this year. Divide the current year into estimated figures and actual figures that you can fill in after this year is over. You'll find it informative to compare figures from year to year and to compare your estimated (budgeted) figures with actual figures.

When your summary is completed, examine it to see how you compare to these recommendedmaximum expenditures as percentages of total income:

Housing - 28%
Installment debt - 20%
Taxes - 20%

If your figures are significantly higher, investigate further to see if you need to make some changes.

Santorini Greece

The villages of Santorini Greece are considered among the most beautiful villages in the Greek islands. Fira and Oia are the most famous villages, perchedon the edge of the caldera and giving amazing view to the Aegean Sea and thevolcano. Firostefani and Imerovigli are also beautiful spots with traditional architecture.

What are the prerequisites and admission requirements for MBA financial planning schools online?

A bachelor’s degree is typically required before students can enroll in online MBA financial planning programs. A bachelor’s degree in subjects like finance, business administration, economics, and CPA may be preferred by some schools that have an MBA financial planning online program.

In addition to requiring students to have a bachelor’s degree, many online MBA in financial planning programs base admission on the following criteria:

• Graduate Management Admission Test scores (GMAT)
• Personal interviews
• Academic transcripts
• References or Letters of Recommendation

Upgrading back-office operations

Upgrading back-office operations: This is where “the most opportunity for efficiencies” is found, according to Dario. Leading firms are creating “composite applications” for rebalancing, portfolio management and CRM to integrate a number of systems to solve a business process, he said. For example, advisors can integrate a custodian’s brokerage system with CRM, a forms filing package, document management system and online signature capability. Composite applications can also cover quarterly performance and billing reports, which usually take weeks to produce, collate and mail, Dario said. Firms that integrated custodians' data feeds with portfolio accounting and performance reporting systems and post the reports on a client portal were able to “dramatically reduce” the time involved, he said. Citing (Financial Planning columnist) Joel Bruckenstein and David Drucker’s book Technology Tools for a High Margin Practice, Dario said firms that leveraged CRM and client portals were able to save more than $30,000 a year, while firms who outsourced portfolio management systems saved nearly $100,000 annually.

"Bottoms in the investment world don't end with four-year lows; they end with 10- or 15-year lows." - Jim Rogers

While 10-15 year lows are not common, they do happen. During these down times, don't be shy about going against the trend and investing; you could make a fortune by making a bold move - or lose your shirt. Remember quote #1 and invest in an industry you've researched thoroughly. Then, be prepared to see your investment sink lower before it turns around and starts to pay off.

Know Where Your Money Goes

Once you've gone through a few personal finance books, you'll realize how important it is to make sure your expenses aren't exceeding your income. The best way to do this is by budgeting. Once you see how your morning java adds up over the course of a month, you'll realize that making small, manageable changes in your everyday expenses can have just as big of an impact on your financial situation as getting a raise. In addition, keeping your recurring monthly expenses as low as possible will also save you big bucks over time. If you don't waste your money on a posh apartment now, you might be able to afford a nice condo or a house before you know it. (Read more on budgeting in our Budgeting 101 special feature.)

Great Blue Hole of Belize

This is the Great Blue Hole of Belize, It is believed that this hole is the world’s largest sea-hole.

Athirapally Vazhachal Waterfalls

The long distance view of the water falls diverted the tourist's attraction from the monkeys. She reaches here after travelling many kilometers from Anamudi through Sholayar forest. When we came here last time, there were no objections for taking a bath or playing around in the river on top of the water falls. But now, bathing there is prohibited. There is no entry beyond the rope which is tied by the forest department. Like a cinema still, there is a palmleaf hut near the water falls. The forest watch men observe the tourists from here. The instant I put my foot on the prohibited area, a whistle was blown. 'Don't go there' – the watchman's warning. The Athirappily which falls to a depth of eighty feet will bring a little fear to your mind.

Usually the tourists coming to Athirappilly, return after viewing the sights from the top. To get the beauty of this water falls registered in your mind, you must go to the bottom where the water strikes to the ground. The way to the bottom is a steep path in the middle of the forest. When we reached the bottom through this granite paved path, the arrogance of the drone increased. 

The sound of the falls is so high that you cannot even communicate with each other. This area is definetly a dangerous place. There is rope tied just before the place where the water falls. Here there are watchmen from the forest department. On another rock, two men clad in bath towels are catching fish.



Travel Info 

Athirappilly is one of the biggest and beautiful waterfalls in India.

Location

East of Chalakkudy in Thrissur dt. adjacent to the Sholayar forests.

How to reach 

By road:Deviate from NH 47 on Chalakkudy (Thrissur Dt.) to Chalakkudy-Anamalai road (SH-21). 30 Kms to Athirappilly.

By Rail:Chalakkudy (30km), Aluva (64km), Ernakulam (101km)

By Air:Cochin International Airport (48km)

Distance Chart

Thrissur (63 km), Chalakkudy (30 km).

Visiting time

8am to 6pm. Visitors should take tickets to enter the picnic spot.
Dont worry it will cost half a dollar for adults.

Measure Against Your Best Investment

Anytime you have more investment capital, your aim for investing should not be diversity, but finding an investment that is better than the ones you already own. If the opportunities don't beat what you already have in your portfolio, you may as well buy more of the companies you know and love, or simply wait for better times. During idle times, a value investor can identify the stocks he or she wants and the price at which they'll be worth buying. By keeping a wish list like this, you'll be able to make decisions quickly in a correction

Dettifoss waterfalls, Iceland.

Dettifoss waterfalls-Iceland.

This waterfall is most powerful waterfall in Europe. The falls are 100 meters wide and have a drop of 45 meters down to the Jokulsargljufur canyon.