text:
Year : 2016 | Volume : 20 | Issue : 7 | Page : 33--41
Perception of care and barriers to treatment in individuals with diabetic retinopathy in India: 11-city 9-state study
Rajan Shukla1, Murthy V. S. Gudlavalleti2, Souvik Bandyopadhyay1, Raghupathy Anchala1, Aashrai Sai Venkat Gudlavalleti1, AT Jotheeswaran1, Srikrishna S Ramachandra1, Vivek Singh1, Praveen Vashist3, Komal Allagh1, Hira Pant Ballabh1, Clare E Gilbert4,
1 South Asia Centre for Disability Inclusive Development Research, Indian Institute of Public Health, Public Health Foundation of India, ANV Arcade, 1 Amar Cooperative Society, Kavuri Hills, Madhapur, Hyderabad, Telangana, India
2 South Asia Centre for Disability Inclusive Development Research, Indian Institute of Public Health, Public Health Foundation of India, ANV Arcade, 1 Amar Cooperative Society, Kavuri Hills, Madhapur, Hyderabad, Telangana, India; Department of Clinical Research, International Centre for Eye Health, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
3 Department of Community Ophthalmology, Dr. R. P. Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
4 Department of Clinical Research, International Centre for Eye Health, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
Murthy V. S. Gudlavalleti
Indian Institute of Public Health, Public Health Foundation of India, ANV Arcade, 1 Amar Cooperative Society, Kavuri Hills, Madhapur, Hyderabad - 500 033, Telangana, India
Background: Diabetic retinopathy is a leading cause of visual impairment. Low awareness about the disease and inequitable distribution of care are major challenges in India. Objectives: Assess perception of care and challenges faced in availing care among diabetics. Materials and Methods: The cross-sectional, hospital based survey was conducted in eleven cities. In each city, public and private providers of eye-care were identified. Both multispecialty and standalone facilities were included. Specially designed semi-open ended questionnaires were administered to the clients. Results: 376 diabetics were interviewed in the eye clinics, of whom 62.8% (236) were selected from facilities in cities with a population of 7 million or more. The mean duration of known diabetes was 11.1 (±7.7) years. Half the respondents understood the meaning of adequate glycemic control and 45% reported that they had visual loss when they first presented to an eye facility. Facilities in smaller cities and those with higher educational status were found to be statistically significant predictors of self-reported good/adequate control of diabetes. The correct awareness of glycemic control was significantly high among attending privately-funded facilities and higher educational status. Self-monitoring of glycemic status at home was significantly associated with respondents from larger cities, privately-funded facilities, those who were better educated and reported longer duration of diabetes. Duration of diabetes (41%), poor glycemic control (39.4%) and age (20.7%) were identified as the leading causes of DR. The commonest challenges faced were lifestyle/behavior related. Conclusions: The findings have significant implications for the organization of diabetes services in India.
Shukla R, Gudlavalleti MV, Bandyopadhyay S, Anchala R, Gudlavalleti AS, Jotheeswaran A T, Ramachandra SS, Singh V, Vashist P, Allagh K, Ballabh HP, Gilbert CE. Perception of care and barriers to treatment in individuals with diabetic retinopathy in India: 11-city 9-state study.Indian J Endocr Metab 2016;20:33-41
Shukla R, Gudlavalleti MV, Bandyopadhyay S, Anchala R, Gudlavalleti AS, Jotheeswaran A T, Ramachandra SS, Singh V, Vashist P, Allagh K, Ballabh HP, Gilbert CE. Perception of care and barriers to treatment in individuals with diabetic retinopathy in India: 11-city 9-state study. Indian J Endocr Metab [serial online] 2016 [cited 2020 Jan 21 ];20:33-41
Available from: http://www.ijem.in/text.asp?2016/20/7/33/179772
Diabetic retinopathy (DR) is a leading cause of visual impairment and blindness throughout the world.[1] It is estimated that the global magnitude of DR will increase from 126.6 million in 2010 to 191 million by 2030.[2] In India, 12–22.4% of known diabetics have DR,[3] which is lower than in high-income countries (30–50%).[3] However, since diabetes occurs at a younger age in Indians than Caucasians,[4],[5] the improving life expectancy in India,[6] means that individuals will now will live longer with diabetes than ever before. Since duration of diabetes is a major risk factor for DR,[1] rates of DR are likely to increase over the next decade.
Low awareness about the disease and inequitable distribution of care are major challenges to providing adequate care to diabetic individuals in India.[7] To ensure that adequate and equitable care is provided to all with DR, it is important to evaluate levels of awareness among people living with diabetes, their perceptions of care, and the barriers they face in accessing services for diabetes and DR. A better understanding of these factors will allow us to address the challenges faced by persons with diabetes in managing their diabetes and DR.
The present study was conducted in 11 cities across India to provide evidence on available human resources, infrastructure, client perceptions and service utilization. We report here the findings regarding perception of care and the challenges faced in availing eye care services among individuals with DR across nine states in India. This information will be used to develop need-based community directed programs for reducing the risk of sight-threatening DR (ST-DR).
The study was a cross-sectional, hospital based survey conducted in 11 cities in nine states across India. Sampling entailed a two stage process wherein cities were first stratified based on their population (more than or less than seven million). Cities to be included in the study were identified by ranking all cities in India in descending order of population size (2011 census) and the 10 most populated cities were first selected. As only one city (Kolkata) from eastern India was represented, an additional city from the eastern part of India was included, i.e., the twin cities of Bhubaneshwar and Cuttack. Thus, 11 cities were finally covered. The 11 cities were Ahmedabad, Bengaluru, Bhubaneshwar (including Cuttack), Chennai, Delhi, Hyderabad (including Secunderabad), Jaipur, Kolkata, Mumbai, Pune, and Surat.
In each city, public and private providers of eye care services were identified. The size of the facility (number of beds) was taken into consideration in classifying the facilities as "large" (dedicated eye hospitals/general hospitals with an eye facility [20 or more bedded hospital with functioning ophthalmic super-specialty services, hospitals with satellite facilities, eye care departments in general hospitals]) or "small" (individual eye care practitioners or eye hospitals with <20 eye beds) for inclusion in the study. The sampling frame was developed using the list of hospitals identified in each city from the internet and from the list of physicians who underwent training in evidence-based diabetes management programs which covered more than 5000 physicians across the country over the past 3 years.
After obtaining permission from hospital administrators at each clinic/facility, outpatients were randomly sampled at eye care hospital/clinics. At each facility, four to six clients with DR were identified among those waiting for doctor's consultation. Care was taken to select comparable numbers of males and females. Patients were stratified by age and then interviewed (<50 years, and ≥50 years). Specially designed semi-open ended questionnaires were administered to the clients waiting in the clinics. Data were entered into an Access-based software package specially developed for the study. All data were cleaned before analysis.
Stata 12 SE for Windows (Stata Corp, Texas, US) was used for statistical analysis. Frequencies of the variables were tabulated. The T-test was used for continuous variables and the Chi-square test was used for categorical variables. Results were adjusted for age, sex, education, type of city, and type of healthcare sector (public or private).
Detailed methodology used in the study has been published as a companion article.
A total of 376 persons with diabetes were interviewed in the eye clinics, nearly a third of whom were recruited in public-funded institutions [Table 1]. Among the 376 respondents, 62.8% (236) were in facilities in cities with a population of 7 million or more (more populated cities). More than half (55.6%) stated that their diabetes had been diagnosed within the last 10 years. The mean duration of known diabetes was 11.1 (standard deviation [SD] ±7.7) years.{Table 1}
The mean age of respondents was 55.6 (±10.5) years. Only a quarter (26.3%) were aged below 50 years and 55.3% were male. A significant proportion (67.8%) had completed either secondary schooling or more (including graduation/postgraduation etc.).
Perception of good glycemic control
Respondents were asked what adequate control of diabetes meant to them. Fifty percent (188) mentioned that adequate control meant that their blood sugar/hemoglobin A1c levels were within normal limits. Three quarters (76.3%; n = 287) stated that they perceived their glycemic control to be adequate/good.
Determinants of self-reported good/adequate control of diabetes, including facility related parameters, demographic characteristics, and some diabetic care patterns, were assessed [Table 2]. On univariate analysis respondents interviewed in smaller cities (85%) reported better perceived glycemic control compared to those from larger cities (71.2%) (χ2 = 9.28; P = 0.002). Statistically significant differences were also observed between younger respondents (83.8%) compared to respondents aged 50 + years (73.6%) (χ2 = 4.19; P = 0.04), those with higher educational attainment (80.8%) compared to those who were less educated (66.9%) (χ2 = 8.70; P = 0.003), and among those respondents who regularly monitored their diabetic status at home (82.7%) compared to those who did not (73.1%) (χ2 = 4.28; P = 0.04).{Table 2}
However, on multivariate analysis, after adjusting for variables which were significantly different on univariate analysis [Table 2], only facilities in smaller cities and clients with higher educational status remained statistically significant.
The correct awareness of glycemic control was significantly higher among respondents attending privately-funded hospitals compared to public-funded hospitals (57.6% vs. 33.6%; χ2 = 18.7; P < 0.001), among those interviewed at exclusive/stand-alone eye hospitals compared to multispecialty hospitals (54.6% vs. 39.5%; χ2 = 7.25; P = 0.007), among the better educated (56.1% vs. 37.8%; χ2 = 11.72; P = 0.001), persons with known diabetes of more than10 years (57.6% vs. 44.0%; χ2 = 6.78; P = 0.009), those who regularly self-monitored their glycemic status (62.1% vs. 44.0%; χ2 = 10.83; P = 0.001) and among those who perceived their glycemic control as adequate (100.0% vs. 18.3%; χ2 = 238; P < 0.001). However, on multivariate analysis only those attending privately-funded facilities and higher educational status remained statistically significant [Table 3].{Table 3}
Determinants of self-reported self-monitoring of glycemic status at home were also assessed [Table 4] with the following variables being statistically significant in univariate analysis: Larger cities vs. smaller cities (38.6% vs. 25.7%; χ2 = 6.48; P = 0.01); private versus public-funded facilities (38.1% vs. 24.4%; χ2 = 6.88; P = 0.009); stand-alone eye facilities compared to eye units in multispecialty eye facilities (36.6% vs. 27.2%; χ2 = 3.17; P = 0.07), higher versus lower educational attainment (41.2% vs. 18.2%; χ2 = 19.4; P < 0.001), longer versus shorter duration of diabetes (52.1% vs. 19.6%; χ2 = 43.44; P < 0.001), and those perceiving their diabetes to be adequately controlled versus those reporting poor control (36.6% vs. 24.7%; χ2 = 4.28; P = 0.04). In multivariate analysis, the associations that remained statistically significant were respondents from larger cities, privately-funded facilities, those who were better educated and those with a longer duration of diabetes [Table 4].{Table 4}
Vision loss at presentation
Almost half the respondents (172, 45.7%) reported that they had some degree of visual loss before they attended an eye care facility. Visual loss was not associated with place or type of facility or demographic characteristics such as age, sex or education but was associated with the knowledge of what constituted adequate control of diabetes (34.9% among those who knew what adequate control meant compared with 58.8% among those who did not know; χ2 = 21.01; P < 0.001) and their perceived level of control of their diabetes (adequate 35.9% compared poor 53.8%, χ2 = 11.37; P = 0.001). Factors such as duration of diabetes or self-monitoring of the glycemic status were associated with presentation with vision loss at an eye clinic before DR was diagnosed.
Place of diagnosis of diabetic retinopathy
Respondents were asked to identify the facility where their DR was first detected, and 72.3% (272) stated it was identified at a secondary or tertiary eye care facility. Vision centers (n = 56; 14.9%) and outreach eye camps (n = 42; 11.2%) were other locations cited. Only 1.6% (6) stated that their DR was first identified at a physician's clinic.
Perceived causes of diabetic retinopathy
Duration of diabetes (41%), poor glycemic control (39.4%) and age (20.7%) were identified as the leading causes of DR [Table 5]. High blood pressure, smoking, and high lipid levels were also mentioned as important causes but 14.6% stated that they were not aware of the causes of DR. Individuals living in smaller cities were more likely to attribute DR to both long duration of diabetes and poor glycemic control than those living in larger cities (20.7% vs. 8.5%; P = 0.001).{Table 5}
Challenges in managing diabetes
The most common challenges respondents faced were lifestyle/behavior related, such as modifying their diet and taking exercise, and access related (including costs) [Table 6]. Nearly three of every ten respondents (29%) mentioned that costs of treatment/investigations or loss of wages were major challenges. Only a fifth stated that they did not face any challenge in managing their diabetes. Those interviewed in the privately-funded hospitals were more likely to report no challenges than those in public-funded eye clinics (25.3% vs. 12.6%; P = 0.005).{Table 6}
Barriers in accessing care for diabetic retinopathy
More than half of the respondents (53.5%) stated that they did not face any barriers in accessing eye care services [Table 7], with the less educated having more barriers than the educated. (44.6% vs. 57.6%; P = 0.02). Among those reporting barriers, the distance was the most important barrier (n = 114, 65.1%) followed by the cost of travel (n = 23, 13.1%).{Table 7}
Awareness of complications of diabetes
The majority of participants (84.0%) were aware that diabetes could be associated with complications, with awareness being greater among those with higher levels of education (89.0% vs. 73.5%; χ2 = 14.64; P < 0.001). Awareness of complications was also significantly higher among those who regularly self-monitored their glycemic control compared to those who did not (92.7% vs. 79.8%; χ2 = 10.44; P = 0.001) and those with a longer duration of diabetes (90.3% vs. 78.9%; χ2 = 8.82; P = 0.003).
Vision loss/blindness was the most common complication mentioned by respondents (62.8%). Kidney failure (59%), heart attack (37%), and foot ulcers (28%) were the other commonly known complications [Table 8]. Participants with higher levels of education were significantly more aware of the following complications - losing a leg (16.1% vs. 8.3%; P = 0.04), kidney failure (69.0% vs. 37.2%; P < 0.001), blindness (69.8% vs. 47.9%; P < 0.001), and heart attack (42.3% vs. 24.8%; P = 0.001).{Table 8}
Blindness was the complication participants were most concerned about (54%) followed by kidney failure (31%) and heart attacks (17%).
Perceptions on management of diabetic retinopathy
Respondents reported that they underwent investigations regularly. When asked when the last investigations were done, the mean duration since the most recent blood tests were done was1.9 ± 2.0 (mean ± SD) months before the interview. Intervals for other investigations were as follows: Blood pressure measurement 2.0 ± 2.0 (mean ± SD) months; weight measurement 2.6 ± 3.4 (mean ± SD) months, and urine testing 3.5 ± 4.9 (mean ± SD) months. Participants in public-funded facilities had more frequent blood tests than those in privately-funded facilities (1.4 ± 1.0 months since the last test vs. 2.1 ± 2.3 months; P = 0.002) and blood pressure measurement (1.6 ± 1.5 vs. 2.1 ± 2.2 months; P = 0.02). Individuals living in larger cities (>7 million) also had more frequent blood tests (1.3 ± 0.8 vs. 2.9 ± 2.8 months; P < 0.001), weight measurements (2.1 ± 3.1 vs. 3.3 ± 3.6 months; P = 0.003), and blood pressure measurements (1.4 ± 1.3 vs. 2.9 ± 2.7 months P < 0.001) compared to respondents from smaller cities.
Respondents were also asked about their awareness of the type of treatment that they received for DR. About a third (34%; n = 129) were awaiting treatment, 31% (n = 117) had received laser treatment, 13% (n = 50) received an eye injection (possibly anti vascular endothelial growth factor) and 11% (n = 41) had undergone surgery for DR with 8% (n = 31) stating that they were told that no treatment was possible.
Sources of information on diabetic retinopathy
A third (33.8%; n = 127) of the respondents had not received any information on DR; whatsoever, with the proportion being higher amongst those living in larger cities compared to smaller cities (39.4% vs. 24.3%; P = 0.003). Among those who had received information 61.7% (n = 232) said that the information was clear and adequate, with those in privately-funded clinics being more satisfied than those in public-funded facilities (67.3% vs. 49.6%; P = 0.001). Individuals living in smaller cities were more likely to report that the information they received was clear and adequate than those living in larger cities (69.3% vs. 57.2%; P = 0.02).
Half of the persons with DR (50.8%) reported being counseled about DR, and 14.1% received information from the clinic in written formats (i.e., a leaflet or a pamphlet). More than half (51.1%) of the respondents also obtained information from other sources (family and friends, health worker, television/radio/newspaper, internet etc.,), this being higher among the better educated (57.2% vs. 38.0%; P < 0.001) and those living in smaller cities (67.1% vs. 41.5%; P < 0.001). They were also more likely to obtain this information from family and friends than their counterparts in the more populated cities (59.3% vs. 19.5%; P < 0.001).
This study is unique at it highlights the perceptions and practices adopted by persons with diabetes attending eye clinics across 11 cities in India. Findings are therefore reflective of what is happening in the country.
Perception of glycemic control
Poor glycemic control is an important risk factor for DR and there is evidence that intensive glycemic control can reduce the incidence and progression of DR.[1],[8],[9],[10],[11] Glycemic control is an excellent indicator of the awareness and behavior of persons with long-standing diabetes. We observed that a significant proportion of our study population perceived their control of diabetes to be adequate or good. This however does not reflect the actual glycemic level of the persons with diabetes. It is important to explore associations between the actual glycemic level and self-reported glycemic level as some studies have shown that misrepresentation of the level of glycemic control is much higher among poorly controlled diabetics.[12]
We observed that half the respondents understood the meaning of adequate glycemic control. The correct interpretation of what constituted "adequate control of diabetes" was significantly higher in private-funded facilities, those who were better educated and those who reported regular self-monitoring of their glycemic state. It was also observed that 100% of respondents who reported that their glycemic control was adequate/good had correct knowledge on what adequate control meant. This implies that the information they had received, from whatever source, was helpful in translating knowledge into practice.
Previous studies have documented that those with a higher educational status were more likely to be aware of diabetes and its complications.[13] Recent studies from Nepal and Turkey showed that higher educational status also enhanced the awareness of DR.[14],[15] A study from Singapore demonstrated that a significant proportion of persons with diabetes were unaware of eye complications and that poor level of awareness was significantly higher among those who had poor glycemic control and other risk factors for DR.[16] They are also more likely to be able to afford devices such as a glucometer, which would enable them to monitor their blood glucose frequently.
As in the present study, in Malaysia, people who regularly tested their glucose levels at home were more literate.[17] There are other factors like financial barriers which can also be a hurdle for persons with diabetes to self-monitor their glycemic control.[18] Our study also observed that literacy is a strong determinant of awareness as well as practice. Similarly, respondents who were attending privately-owned facilities generally had better awareness and practiced self-monitoring of glycemic control at home significantly more than those attending public-funded facilities. There could be many confounders including literacy and socioeconomic status which may be more important than mere attendance at privately-owned facilities and could reflect better counseling and access to health information.
Vision at presentation to an eye facility
We observed that 45% of the respondents reported that they had visual loss when they first presented to an eye facility and before their DR was detected. This is consistent with findings reported from many parts of the world that between 25 and 50% of persons with diabetes present with visual loss at the first visit to an eye facility.[19],[20],[21] In a long-standing condition like diabetes, compliance with medication and follow-up is a major problem. Therefore, educational/counseling interventions for persons with diabetes should emphasize the critical importance of regular medication and glycemic control as well as the need for regular retinal examination even if they do not have symptoms of visual loss.
We observed that even though nearly half the persons with diabetes presented with vision loss at attendance, only 1.6% stated that their DR had been detected at a diabetic physician's clinic. This is critical as it means that there is an urgent need for a paradigm shift wherein screening for DR should be undertaken at a diabetic service rather than wait for a person with diabetes to come to an eye care facility if vision loss is to be prevented effectively. This needs an integrated approach where the eye care and diabetic care services work together toward the goal of improved quality of life of all persons with diabetes.
Perception of cause of diabetic retinopathy
Long duration of diabetes and poor glycemic control were identified as causes of DR in the present study. Previous studies in India have reported poor awareness about causation of DR. A study in South India observed that though 84% of diabetics could identify that diabetes caused eye problems, only 19% stated that it could affect the "nerves in the eye" (presumed to be retinopathy by the authors).[22] A study in South Central India documented that only 27% of an urban population were aware of DR,[23] while among self-reported diabetics in another study in South India, 57.8% knew about eye complications.[24] However, only 5.8% of the self-reported diabetics could attribute long duration of diabetes as a cause for DR.
We observed that respondents from smaller cities were better informed about the causes of DR compared to respondents in the bigger cities. This is interesting as it is generally perceived that bigger cities provide better opportunities to access information.
Challenges and barriers in controlling diabetes
Lifestyle modifications and cost of managing diabetes were major challenges in the present study. In contrast, only 13% felt that taking medications was a challenge. This reflects that lifestyle modification is a bigger challenge for controlling diabetes in India rather than compliance with anti-diabetic treatment. Similar challenges in relation to diet modification,[25] or exercise,[26] have also been identified in other parts of the world among diabetes of South Asian origin. The beneficial effects of lifestyle modifications have been well documented and are also more cost-effective, but lifestyle modification requires consistent motivation, discipline, and support from family members.[27],[28] It is, therefore, important that physicians and affiliated health care personnel counsel and motivate patients and their families to ensure adherence to lifestyle modification at each visit to the clinic.
It was encouraging to see that more than half the study population did not perceive any barrier to accessing healthcare. Individuals with a higher education were less likely to report barriers to access. About a third of the patients felt that distance was a barrier. This was irrespective of the sector or type of city.
Perception of complications
Eighty-four percent of individuals were aware of the complications of diabetes which is comparable to the Indian Council Medical Research Study where 72.7% of known diabetics were aware of complications.[29] In our study visual loss and renal failure were the most common complications listed by the respondents, which is similar to studies in Turkey and Malaysia, where nearly 9 of 10 persons with diabetes stated that diabetes can affect the eyes.[15],[21],[30] In India, awareness of eye complications of diabetes among self-reported diabetics ranges from 40 to 80%.[22],[24] The greater awareness of eye and kidney complications in diabetes is corroborated by a study which showed that among persons with diabetes, awareness about microvascular complications such as vision loss and nephropathy seemed to be higher than the awareness of macrovascular complications such as heart attack and stroke.[24]
Our study had a few limitations. Being a hospital-based study, it may not be representative of the general urban population and data were collected using a standard questionnaire and recall bias cannot be ruled out.
In conclusion, our study highlights the perceptions of treatment and care among individuals with DR. This information will help in developing evidence-based strategies for reducing the risk of ST-DR in India.
The study was supported through a grant from the Queen Elizabeth Diamond Jubilee Trust (a noncharitable organization), London, UK.
1 Tapp RJ, Zimmet PZ, Harper CA, McCarty DJ, Chitson P, Tonkin AM, et al. Six year incidence and progression of diabetic retinopathy: Results from the Mauritius diabetes complication study. Diabetes Res Clin Pract 2006;73:298-303.
2 Zheng Y, He M, Congdon N. The worldwide epidemic of diabetic retinopathy. Indian J Ophthalmol 2012;60:428-31.
3 Raman R, Rani PK, Reddi Rachepalle S, Gnanamoorthy P, Uthra S, Kumaramanickavel G, et al. Prevalence of diabetic retinopathy in India: Sankara Nethralaya Diabetic Retinopathy Epidemiology and Molecular Genetics Study report 2. Ophthalmology 2009;116:311-8.
4 Ramachandran A, Snehalatha C. Current scenario of diabetes in India. J Diabetes 2009;1:18-28.
5 Ramachandran A, Mary S, Yamuna A, Murugesan N, Snehalatha C. High prevalence of diabetes and cardiovascular risk factors associated with urbanization in India. Diabetes Care 2008;31:893-8.
6 Panigrahi DN. Life expectancy in India: Contributing factors. Int J Innov Res Dev 2014;3:249-53.
7 Venkataraman K, Kannan AT, Mohan V. Challenges in diabetes management with particular reference to India. Int J Diabetes Dev Ctries 2009;29:103-9.
8 Kim YJ, Kim JG, Lee JY, Lee KS, Joe SG, Park JY, et al. Development and progression of diabetic retinopathy and associated risk factors in Korean patients with type 2 diabetes: The experience of a tertiary center. J Korean Med Sci 2014;29:1699-705.
9 Aiello LP, DCCT/EDIC Research Group. Diabetic retinopathy and other ocular findings in the diabetes control and complications trial/epidemiology of diabetes interventions and complications study. Diabetes Care 2014;37:17-23.
10 Harris Nwanyanwu K, Talwar N, Gardner TW, Wrobel JS, Herman WH, Stein JD. Predicting development of proliferative diabetic retinopathy. Diabetes Care 2013;36:1562-8.
11 Tam VH, Lam EP, Chu BC, Tse KK, Fung LM. Incidence and progression of diabetic retinopathy in Hong Kong Chinese with type 2 diabetes mellitus. J Diabetes Complications 2009;23:185-93.
12 Suzuki-Saito T, Yokokawa H, Shimada K, Yasumura S. Self-perception of glycemic control among Japanese type 2 diabetic patients: Accuracy ?of patient perception and characteristics ?of patients with misperception. J Diabetes Investig 2013;4:206-13.
13 Caliskan D, Ozdemir O, Ocaktan E, Idil A. Evaluation of awareness of diabetes mellitus and associated factors in four health center areas. Patient Educ Couns 2006;62:142-7.
14 Thapa R, Poudyal G, Maharjan N, Bernstein PS. Demographics and awareness of diabetic retinopathy among diabetic patients attending the vitreo-retinal service at a tertiary eye care center in Nepal. Nepal J Ophthalmol 2012;4:10-6.
15 Cetin EN, Zencir M, Fenkçi S, Akin F, Yildirim C. Assessment of awareness of diabetic retinopathy and utilization of eye care services among Turkish diabetic patients. Prim Care Diabetes 2013;7:297-302.
16 Huang OS, Tay WT, Tai ES, Wang JJ, Saw SM, Jeganathan VS, et al. Lack of awareness amongst community patients with diabetes and diabetic retinopathy: The Singapore Malay eye study. Ann Acad Med Singapore 2009;38:1048-55.
17 Mastura I, Mimi O, Piterman L, Teng CL, Wijesinha S. Self-monitoring of blood glucose among diabetes patients attending government health clinics. Med J Malaysia 2007;62:147-51.
18 Zgibor JC, Simmons D. Barriers to blood glucose monitoring in a multiethnic community. Diabetes Care 2002;25:1772-7.
19 Thapa R, Joshi DM, Rizyal A, Maharjan N, Joshi RD. Prevalence, risk factors and awareness of diabetic retinopathy among admitted diabetic patients at a tertiary level hospital in Kathmandu. Nepal J Ophthalmol 2014;6:24-30.
20 Damato EM, Murray N, Szetu J, Sikivou BT, Emma S, McGhee CN. Sight-threatening diabetic retinopathy at presentation to screening services in Fiji. Ophthalmic Epidemiol 2014;21:318-26.
21 Tajunisah I, Wong P, Tan L, Rokiah P, Reddy S. Awareness of eye complications and prevalence of retinopathy in the first visit to eye clinic among type 2 diabetic patients. Int J Ophthalmol 2011;4:519-24.
22 Saikumar SJ, Giridhar A, Mahesh G, Elias A, Bhat S. Awareness about eye diseases among diabetics - A survey in South India. Community Eye Health 2005;18:97.
23 Dandona R, Dandona L, John RK, McCarty CA, Rao GN. Awareness of eye diseases in an urban population in southern India. Bull World Health Organ 2001;79:96-102.
24 Namperumalsamy P, Kim R, Kaliaperumal K, Sekar A, Karthika A, Nirmalan PK. A pilot study on awareness of diabetic retinopathy among non-medical persons in South India. The challenge for eye care programmes in the region. Indian J Ophthalmol 2004;52:247-51.
25 Suzuki T, Takei R, Inoguchi T, Sonoda N, Sasaki S, Kaise T, et al. Clinical significance of barriers to blood glucose control in type 2 diabetes patients with insufficient glycemic control. Patient Prefer Adherence 2015;9:837-45.
26 Lawton J, Ahmad N, Hanna L, Douglas M, Hallowell N. 'I can't do any serious exercise': Barriers to physical activity amongst people of Pakistani and Indian origin with Type 2 diabetes. Health Educ Res 2006;21:43-54.
27 Aguiar EJ, Morgan PJ, Collins CE, Plotnikoff RC, Callister R. Efficacy of interventions that include diet, aerobic and resistance training components for type 2 diabetes prevention: A systematic review with meta-analysis. Int J Behav Nutr Phys Act 2014;11:2.
28 Maiorana A, O'Driscoll G, Goodman C, Taylor R, Green D. Combined aerobic and resistance exercise improves glycemic control and fitness in type 2 diabetes. Diabetes Res Clin Pract 2002;56:115-23.
29 Deepa M, Bhansali A, Anjana RM, Pradeepa R, Joshi SR, Joshi PP, et al. Knowledge and awareness of diabetes in urban and rural India: The Indian Council of Medical Research India Diabetes Study (Phase I): Indian Council of Medical Research India Diabetes 4. Indian J Endocrinol Metab 2014;18:379-85.
30 Addoor KR, Bhandary SV, Khanna R, Rao LG, Lingam KD, V S B, et al. Assessment of awareness of diabetic retinopathy among the diabetics attending the peripheral diabetic clinics in melaka, malaysia. Med J Malaysia 2011;66:48-52.


On September 11, 2001, Arlington County Police officers responded to the Pentagon to face one of the most horrific acts of terrorism this nation has ever experienced. Since 2001, Arlington County has enhanced our public safety response capabilities. As a result, today, we are stronger, and better prepared for any event, than ever. While we are enhancing public safety readiness, the Arlington County Police Department recognizes the value residents, visitors and businesses play as an extra set of eyes and ears in our community. If you see something, say something® – report possible safety or security concerns to law enforcement for investigation.
Report suspicious activity by contacting the Emergency Communications Center at 703-558-2222 or 9-1-1 in an emergency.
"If you See Something, Say Something®" is a national anti-terrorism campaign, launched by the U.S. Department of Homeland Security, that raises public awareness of the indicators of terrorism and terrorism-related crime, as well as the importance of reporting suspicious activity to law enforcement.
The Arlington County Police Department's Homeland Security Section leads efforts within the agency to detect, prevent and investigate terrorist activities that may affect Arlington County and the National Capital Region. The Section collaborates with other law enforcement and intelligence agencies, sharing and compiling intelligence data and provides training and safety awareness to police personnel and the community. The Section also assigns officers to the FBI Joint Terrorism Task Force (National Capital Region), so that Arlington remains informed and connected with our regional law enforcement partners.
Efforts to address crime and threats in our community are most effective when they involve strong collaboration and partnerships between law enforcement and the communities and citizens they serve. That's why police encourage the public to remain aware of your surroundings at all times. While we share everyday moments with our neighbors, family, coworkers, and friends, we all have routines that are uniquely our own making you most well-acquainted with what activities may be suspicious in your neighborhood and communities.
While remaining aware of your surroundings should be part of our everyday, there are areas where residents are encouraged to remain particularly vigilant. These areas include special events or activities in which large crowds of people typically gather such as shopping centers, restaurant districts, religious services, and public transportation hubs to name a few.
Factors such as race, ethnicity, national origin, or religious affiliation alone are not suspicious. The public should report only suspicious behavior and situations rather than beliefs, thoughts, ideas, expressions, associations, or speech unrelated to terrorism or other criminal activity. Suspicious person(s), items, vehicles, and unattended packages should be reported to the police immediately.
If at your residence/place of business, were you expecting any deliveries?
Is the package located in an area that could cause harm (for example, is the package located by a busy Metro entrance vs. in the middle of the woods)?
Did you or anyone around see who left the package? If so, did it appear they intentionally left it or were just distracted and forgot it?
When in doubt – report it to police!
Contact police who have a specially trained explosive ordnance disposal (EOD) K9 program and work collectively with the Fire Department's Bomb Squad.


text:
New York, USA: 55.405 locations
October weather forecast and climate
ClimateJFMAMJJASOctoberNDYear
Weather in Octubre
Average sea temperature in October
Average daylight in October
In Great River, New York, the average seawater temperature in Octubre is 63.7°F (17.6°C).
Note: For swimming, a surface water temperature of 63.7°F (17.6°C) is not enjoyable for the majority. It is not considered safe, as controlling breathing becomes progressively more difficult as water temperature decreases below 69.8°F (21°C).
In Octubre, the average length of the day in Great River is 11.1h.
What is the ocean temperature in Octubre in Great River?
In Great River, the average seawater temperature in Octubre is 63.7°F (17.6°C). For most, swimming in 63.7°F (17.6°C) is not an enjoyable activity. Furthermore, controlling your breathing becomes progressively more difficult as the water temperature decreases from 69.8°F (21°C) to 59°F (15°C).
How many hours of daylight does Great River have in Octubre?
In Great River, the average length of the day in Octubre is 11.1h.
Average sea temperature in October: 63.7°F
The best month for swimming (with the highest average sea temperature) is August (74°F).
The coldest month (with the lowest average sea temperature) is February (39.7°F).
Average daylight in October: 11.1h
Weather Atlas: Great River, NY - October weather forecast and climate information. Great River, New York, USA - October weather averages including high and low temperatures, humidity, rainfall, snowfall, daylight, sunshine, UV index, and sea temperature. [2371730]

redpajama_set_name: RedPajamaCommonCrawl


I hadn't visited some of my old favorite haunts for awhile so yesterday we took a drive on Highway 17S and detoured down all kinds of remote dirt roads. Finished it off with a visit to the famous Harold's Country Club in Yemassee where we ate an enormous steak for dinner. Here are some of the images.
I've been to Harold's but never at dinner time. I hear it is good!


text:
Q: How to append content to an array in a php file I have a PHP file a configuration file coming from a Yii2 message translation file which contains this:
return[

   'Juventus' => '尤文图斯',
   'Milan' => '米兰',
];

I want to append values to the array so i can get something like below:
return[

  'Juventus' => '尤文图斯',
  'Milan' => '米兰',
  'Chelsea' => '切尔西',
];

Note: Another element added to the array
But then below is the result i got rather
return[

  'Juventus' => '尤文图斯',
  'Milan' => '米兰',
];

'Chelsea' => '切尔西',

The new element rather was added outside of the array
I'm using file_put_contents() to append the file like this..
file_put_contents($file, "'Chelsea' => '切尔西'," . PHP_EOL, FILE_APPEND);

How can i solve the problem or what's the better away of doing this.. Any help will be appreciated

A: Read the file, insert the line you want before the ] line, and write the result back to the file.
$contents = file_get_contents($file);
str_replace('];', "'Chelsea' => '切尔西'," . PHP_EOL . '];', $contents);
file_put_contents($file, $contents);

It would probably be better if you made it a data file instead of a PHP script. You can format using json_encode() or serialize().

redpajama_set_name: RedPajamaStackExchange


New Delhi: Aiming to reduce the expenditure incurred by common patients on treatment of cancer and heart diseases, Union Health Minister J.P. Nadda on Friday inaugurated an AMRIT pharmacy at the city-based Safdarjung hospital, saying similar facilities will be across the country.
The new AMRIT (Affordable Medicines and Reliable Implants for Treatment) Pharmacy, the 10th such in the country, will sell drugs at highly discounted rates.
"More than 195 drugs for treatment of Cancer and 186 drugs for treatment of Cardiovascular Diseases are being sold through AMRIT with a discount of more than 90 per cent are available to patients," said Nadda.
According to the ministry, the outlets have a very comprehensive list of medicines that are available across range of products.
Nadda informed that more than 1.77 lakhs patients have been benefited till date from the AMRIT pharmacies, which has resulted in saving of around Rs 13 crores out of pocket expenditure to the patients which translates into an average discount of 69 per cent on MRP.
On the future plans of opening AMRIT pharmacies, Nadda said: "We are planning to open 300 outlets in the country. AMRIT pharmacy reflects our strong commitment to reduce the cost of treatment for the patients."
The project has been floated in a tie-up with government-owned HLL Lifecare Ltd, which is mandated to establish and run the AMRIT chain of pharmacies across the country.


text:
Global Fisheries Hit by Climate Change and Overfishing
Finding a greener future
Jeremy Elton Jacquot
Image from Greenpeace
It's bad enough fish already have to deal with the consequences of overfishing; now, according to a new study authored by a team of UBC fisheries scientists, dozens will be faced with the prospect of extinction by 2050. Even slight fluctuations in temperature could cause many cold water species to perish as they attempt to seek out new, more amenable habitats, reports ScienceNOW's Christopher Pala.
Another study authored by Daniel Pauly, a fisheries expert at UBC, has found that fisheries catches in some tropical island countries may be up to 17 times higher than officially reported, writes IPS's Stephen Leahy.
Image from Omer Simkha
Using a model that tracked a range of habitat conditions, including water temperature and depth from sea ice, to predict which habitats would be most impacted by climate change, William Cheung, the study's lead author, and his colleagues found that around 50 species of commercial fishes living near or at the poles will go extinct within the next 4 decades. Those species that can will try migrating toward the Arctic and Southern oceans or end up trapped in closed seas.
While fisheries species in colder waters succumb to climate change, those living in tropical waters will also be feeling the heat from overfishing. According to Pauly, all of the 20 Pacific island nations in his study underreported catches because they didn't include the catch of local fishers (something developed nations like the U.S. fail to do as well).
The problem is that governments, scientists and major international organizations like the FAO rely on this faulty data to decide on fish quotas and licensing. The aid money some of these groups funnel to fisheries in developing countries often ends up benefiting large commercial-scale fisheries, the study also found. Most of these fish end up being exported to wealthy countries. As a result, local fishers may be forced to increase their catch rates -- aggravating an already serious predicament -- in order to survive.
You can read more about Cheung's model and UBC's "Sea Around Us" project, which monitors global catch rates, at the Fisheries Center website.
More on overfishing
::Pacific Tuna Overfishing to be Addressed in Panama City
::Your Crab Cake May Be Permanently On Back Order
::Bluefin Tuna Fishing Ban Has France Upset
It's bad enough fish already have to deal with the consequences of overfishing; now, according to a new study authored by a team of UBC fisheries scientists, dozens will be faced with the prospect of extinction by 2050. Even
Related Content on Treehugger.com
Kroger to create and adopt a no-deforestation policy
Insects could be gone in a century; catastrophic collapse to ensue
Make your garden irresistible to butterflies with these plants and ...
We are witnessing the collapse of nature


text:
News > Midsized Companies
Krispy Kreme SEC probe widens
Doughnut retailer, facing accounting questions, now under formal investigation; shares fall.
October 8, 2004: 2:03 PM EDT
NEW YORK (CNN/Money) - Krispy Kreme Doughnuts Inc. said Friday it has been informed by the Securities and Exchange Commission that the agency's investigation of the company has now become a formal probe.
Shares of Krispy Kreme (KKD: Research, Estimates) fell about 4 percent on the New York Stock Exchange. Krispy Kreme's stock is down 65 percent year-to-date.
Krispy Kreme announced in July that the SEC was conducting an informal, non-public probe into the company's accounting.
At the time, the Winston-Salem, N.C.-based chain, which is struggling to right its slowing sales, said that the investigation involved the way it accounted for its repurchased franchises and its previously announced reduction in earnings guidance.
Scott Livengood, the company's CEO and chairman, had said the company would cooperate with authorities.
"This is definitely very bad news," said Carl Sibilski, analyst with Morningstar wrote in a research note Friday. "Until now, we had given the company's management the benefit of the doubt with respect to certain franchise-acquisition activities. We believe that the SEC's decision indicates that, for some reason, cooperation between the company and the agency in the preceding informal investigation broke down, leading the commission to seek the greater legal powers of a formal investigation."
Sibilski removed his investment rating on the company following Friday's announcement. He previously had a "buy" rating and a $23 price target on the stock.
"We continue to believe that the Krispy Kreme brand has value that may be realized upon clearance of the investigation," Sibilski added. "However, the risk of not knowing exactly what's going on inside the company has escalated to the extent that we no longer have the reasonable confidence necessary to issue an investment rating at this time."
or Create your own
In May, Krispy Kreme issued its first-ever profit warning, citing the adverse effect of the low-carb diet trend on its business. Krispy Kreme also pulled back its forecasts for the rest of this year and fiscal 2005 and put the brakes on new store openings.
The profit warning was followed subsequently by a number of shareholder lawsuits alleging that Krispy Kreme had misled investors about the direction its business was headed.
Bala Cynwyd, Pa.-based law firm Schiffrin & Barroway LLP, filed a lawsuit in May on behalf of all purchasers of Krispy Kreme shares from Aug. 21, 2003 through May 7, 2004.
The complaint named members of Krispy Kreme's senior management as defendants, and charged that they disregarded signs that the company had expanded too quickly, that its wholesale business undermined sales at its retail stores, and that it faced stiff competition from rival doughnut chain Dunkin' Donuts.
Earlier this week, the company appointed two new directors to lead an internal investigation of accounting practices and claims made in shareholder lawsuits against the company as well as issues raised by Krispy Kreme's auditors, PricewaterhouseCoopers.
--*Disclaimer
More on NEWS
• JPMorgan dramatically slashes Tesla's stock price forecast
• Greece is finally done with its epic bailout binge
• Europe is preparing another crackdown on Big Tech
• 7 things to know before the bell
• SoftBank and Toyota want driverless cars to change the world
• Aston Martin falls 5% in its London IPO


text:
ROSARIAN ACADEMY BECOMES THE FIRST CARNEGIE STEM EXCELLENCE PATHWAY PARTNER IN FLORIDA
Incoming Head of School Linda Trethewey recently announced Rosarian Academy is partnering with Carnegie Science Center as the first Carnegie STEM Excellence Pathway partner in the state of Florida.
Niki Atteridge, Oliver Kerkoiran, Beau Kimler, and Sterling Nolff test the Rube Goldberg machine they built during their STEM Lab class at Rosarian Academy.
"As we look to the future of Rosarian and set curricular objectives, I am thrilled that we are moving into a partnership with Carnegie Science Center. We are ready to take a big step and move our STEM program out of its infancy," said Mrs. Trethewey who will be Head of School effective July 1.
Carnegie STEM Excellence Pathway is designed to help schools adopt best practices in STEM education.
"Our goal is to infuse STEM into all areas of the curriculum at all grade levels. To achieve this goal, we will meet with Science Center STEM experts to help us develop a tailored plan to strengthen our STEM curriculum," added Mrs. Trethewey.
The Pathway is a process of continuous improvement that provides guidance to schools on how best to address the challenge of strengthening their STEM programming. The Pathway has attracted over4,600 participating schools or districts in 22 states and the District of Columbia and serves over 1.5 million students.
Kindergarten students, Annabelle Coleman and Olivia Logsdon, participate in a Star Wars activity where they used coding blocks to help BB-8 gather metal.
Rosarian is working with Toni Stith, the STEM Professional Development Manager, Chevron Center for STEM Education & Career Development at Carnegie Science Center in Pittsburgh, PA. Toni has worked with many schools across the country in assessing, planning for, and executing their STEM initiatives in tandem with the Carnegie STEM Excellence Pathway.
The school will first evaluate itself on 20 criteria pertinent to quality STEM education and then develop a tailored strategy to identify and address specific self-defined goals, which are reinforced throughout the students' experiences in the classroom and during out-of-school time.
Fourth-graders Liam Stetson and Landon Ferguson use Lego EV3s to build a robot that folds t-shirts in after-school Tech Club.
Through Carnegie Science Center, Rosarian will provide intensive professional development sessions for teachers in June at the conclusion of the school year and then prior to the start of school in August. The entire STEM professional development program has been funded by a generous gift from Palm Beach resident Estelle Curran, grandmother of Sophia, Serena and Preston who all attend Rosarian.
This shared learning process and continuous curricular improvement is the school's commitment to preparing its students for any career path in the 21st century.
According to Trethewey, "We continue to fulfill our mission of educating the whole person for life and providing a foundation for life."
Rosarian Academy, founded in 1925, educates students from early childhood through eighth grade and offers an exceptionally strong academic program enriched by athletics, visual and performing arts, and community service opportunities. STEM, coding, art, drama, music theory, and Spanish classes begin in kindergarten. The independent, Catholic school is located on Flagler Drive in downtown West Palm Beach and is sponsored by the Adrian Dominican Sisters. Complimentary bus service is available throughout Palm Beach County. For more information, visit www.rosarian.org or call 561.345.3106.


text:
Publication Ethics & Malpractices
Instructions to Author
Vol 28 No 7-8 (1988): July 1988
Ceftriaxone Therapy of Bacterial Meningitis in Children
DOI https://doi.org/10.14238/pi28.7-8.1988.141-7
Sumarmo Sumarmo
Department of Child Health, Universitas Indonesia Medical School/Dr. Cipto Mangunkusumo Hospital, Jakarta
S. R. Harun
M. A. Nathin
Twenty-nine children, age 3 months to 11 years, admitted with the clinical diagnosis of bacterial meningitis to the Department of Child Health, were included in a prospective treatment study of ceftriaxone (RocephinHoffmann- La Roche AG Bas/e, Switzerland). Ceftriaxone was used as the only antibiotic agent in single daily dose of 100 mg/kg body weight given intravenously for a minimum of 10 days. Of these 29 patients, 25 (86.2%) recovered, 3 (10.3%) died and 1 (3.4%) no respond to treatment. Among fatal cases, two patients had subdural empyema and one had a cerebral abscess. The microorganisms isolated from cerebrospinal fluid were: Streptococcus pneumoniae (5), Pseudomonas sp. (4), Proteus sp. (2), Salmonella typhi (1), Escherichia coli (1), Clostridium sp. (1), Pseudomonas aeruginosa (1), Staphylococcus aureus {1), and Streptococcus haemolyticus (1). In 12 patients (41,4%), organisms were not identified. The diagnosis was made based on clinical symptoms, Gram staining, cell count. ~!·tease, and protein in the CSF. In all patients, repeated spinal fluid cultures had no bacterial growth at 24 hours after initation of intravenous therapy. No evidence of clinical important drug toxicity was observed. Three p'Oiients, however, had lightly elevated hepatic transaminase levels, and one patient had rnild neutropenia. These clinical and bacteriological results suggested that ceftriaxone is reasonably safe and effective in the treatment of bacterial meningitis caused by the most common pediatric pathogens in Indonesian children over one month of age.
Sumarmo S, Harun S, Nathin M. Ceftriaxone Therapy of Bacterial Meningitis in Children. PI [Internet]. 26Jul.2019 [cited 18Jan.2020];28(7-8):141-. Available from: https://paediatricaindonesiana.org/index.php/paediatrica-indonesiana/article/view/2249
Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
1. CONGENI, B.L.; BRADLEY, J .; HAMMERRSCHLAG, M.R.: Safety and efficacy of once daily ceftriaxone for the treatment of bacterial meningitis . Pediat. Infect. Dis. 5 : 293 (1986) .
2. DEL RIO, M.A. ; SHELTON, S.; CHRAHNE D.; Me CRACKEN Jr.G.H.; NELSON, J.D.: Ceftriaxone versus ampicillin and chloramphenicol for treatment of bacterial meningitis in children . Lancet i : 1241 (1983).
3. HAVLIK, J .; DUNIEWICSZ, M.; STANKOVA, M.; MARESOVA, V.: Ceftriaxone in the treatment of severe infections in childhood, especially bacterial meningitis. In: Rocephin: World wide literature review 1982-1984. P.T. Roche Indonesia Medical Information Service, Jakarta, p . 142- 143 (1987) .
4. LOLEKHA, S.; BOONRUMLUCKTANOM, S.; CHAROENPIPOP, D.: In vitro activity of ceftriaxone. In: Proceedings: progress in therapy of bacterial infect ions. A new cephalosporin: ceftriaxon"e. Excerpta Med. Asia Pasific Congr. Ser., No. 19, p . 38 (1983),
5. STOECKEL, K.; Me NAMARA, P.J .; BRANDT, R.; PLOZZA-NOTTEBROCK, H.; ZIEGLER, W .H.: Effects of concentration-dependent plasma protein bi"nding on ceftriaxone kinetics. Clin. Pharmacal. Ther. 29 : 650 (1981) .
6. STOECKEL, K.!Selected aspects of ceftriaxone kinetics . Excerpta Med. Asia Pasific Congr. Ser., No. 49, pp. I - 10 (1986).
7. SUMARMO; MUSLIM A. NATHIN; SOFY AN ' ISMAEL; TUMBELAKA, W.A.F.J .: Salmonella meningitis in the newborns and young infants in Jakarta, Indonesia. Paediatr. Indones. 22 : 198 (1982).
Author Form
Our journal is indexed by:
Asian Citation Index
SINTA Indonesia
ISJD
PKP Index
Free Medical Journals
Tweets by PIndonesiana
E-ISSN 2338-476X | P-ISSN 0030-9311
IDAI Building
Jl. Salemba I No 5 Jakarta 10430
Email: enquiry [at] paediatricaindonesiana.org


text:
Tag Archives: Martha Aasen
Remembering Larry Aasen
Larry Aasen — one of Westport's oldest, most beloved residents, and a man who with his late wife Martha contributed immeasurably to the town in countless ways — died this morning at Norwalk Hospital. He was 99 years old.
Martha died in October 2020, age 90. An improbable couple — he was from North Dakota; she was from Mississippi — they prodded and nurtured this town, both politically and civically. They moved here in 1963, and lived here until their deaths.
The family will issue a more complete obituary soon, along with information on memorial donations. A memorial service will be held this spring. They request that no flowers or gifts be sent to the Aasen residence.
In 2018 — when Larry served as grand marshal of the Memorial Day parade — I wrote this:
"This is incredible. I'm 95. At my age, you don't get many awards."
That's Larry Aasen's reaction to being named grand marshal of the 2018 Memorial Day parade.
The World War II airborne sergeant — and 55-year Westport resident — will ride the route from Riverside Avenue down the Post Road, and up Myrtle Avenue to Veterans Green, on Monday, May 28. There, he'll give the keynote address.
Aasen — and many other Westporters — hope the 3rd time's the charm. The 2 previous Memorial Day parades have been canceled due to weather. The grand marshals delivered their addresses in the Town Hall auditorium.
Larry Aasen, at last year's Memorial Day parade.
Aasen has a lot to talk about.
He was born in a log cabin in the middle of a North Dakota snowstorm. There was no electricity, running water, central heating — not even a bathroom.
Aasen rose to sergeant in the 13th Airborne. After training in North Carolina, he was sent to France. His division had 20-person gliders, with no protection. The mission was to drop behind enemy lines, and destroy anything of value. Gliders had a 70% casualty rate, Aasen says.
His job was cryptographer, encoding and decoding secret messages. He had a security clearance from the FBI.
After his discharge in 1946, Aasen earned a journalism degree from the University of North Dakota. He headed east, for a master's at Boston University.
Aasen moved to New York, "to seek my fortune." He spent 14 years with New York Life Insurance, rising to vice president of public relations, then 20 years with the Better Vision Institute on campaigns urging Americans to get their eyes checked. Aasen worked with Bob Hope, Muhammad Ali and other celebrities on those projects. (He's also met 6 US presidents.)
When they posed for this photo, President Obama said to Larry Aasen, "let's put the rose (Martha Aasen) between 2 thorns."
In 1963, he, his wife Martha and their young children moved to Westport. "We needed more room than a New York apartment," he explains. "There were a lot of media people here, and they loved it."
He and Martha live in the same Ellery Lane house they bought over half a century ago. He calls it "the best investment we ever made."
Aasen served 17 years on the Representative Town Meeting (RTM). His other volunteer activities include the Democratic Town Committee, Y's Men, Rotary Club and Saugatuck Congregational Church.
Larry and Martha Aasen have not missed a Memorial Day parade in 54 years. This year, he'll have a special role in it.
A well-deserved honor for one of Westport's favorite 95-year-olds.
There's this story too, from when Larry turned 95 years young in 2017:
On December 5, Larry Aasen turns 95 years young.
As the big day nears, he's going through scrapbooks and albums. Recently, in the Ellery Lane home he and his wife Martha have lived in for 54 years, Aasen recalled some intriguing stories.
He was born in 1922, in a log cabin in the middle of a North Dakota snowstorm. There was no electricity, running water, central heating — not even a bathroom.
When he got to New York City in 1949, he heard about a Times Square "gag writers school." The $5 tuition was put into a hat, at the beginning of class.
Aasen went on to work for the Better Vision Institute. Its mission was to encourage regular eye exams.
The organization used celebrities in its ads. Because he had eye problems, Bob Hope did radio and TV ads for free. Toward the end of the comedian's career, Aasen did a fundraiser with him in Miami. He was tired and weak. But when the spotlight hit him, he did a jig, picked up his violin and performed well.
Bob Hope (left) and Larry Aasen (right).
One day, a friend gave Aasen Muhammad Ali's phone number. Aasen told the boxing champ the BVI wanted to use his photo on a poster. Ali, however, was more concerned about how Aasen had gotten his number.
Aasen explained that the poster would read, "Your fists can't hit what your eyes can't see!" Ali yelled "Okay!" — then slammed down the receiver.
Aasen and his wife are political junkies. In his long life, he's met 6 presidents.
In 1950, while working as a writer/photographer for the Journal of Accountancy in New York, he was assigned to take photos of CPAs at the Waldorf Astoria. Hurrying over, he knocked down a frail old man. When he got up, Herbert Hoover gave Aasen a stern look and said, "Watch where you are going!"
Five years later, in Kansas City, Aasen learned where Harry Truman parked his car for his daily walk to work. Sure enough, at 8:15 a.m. he drove up.
It was snowing hard. The former president was all alone. Aasen asked if he could walk along. Truman smiled, and asked Aasen where he was from.
He said North Dakota, and that his wife was from Mississippi. The two men talked about those states' senators, as well as the Hayes/Tilden "stolen" election of 1876. Then, after a firm handshake, Truman bounded up the office steps.
Martha and Larry Aasen.
In 1960, Martha's father was a Mississippi delegate to the Democratic convention. The state shared a "very poor hotel" with the Wyoming delegation. Though they were small, and seemingly unimportant at the end of the roll call, candidate John F. Kennedy arrived at the hotel to meet them.
Kennedy jumped out of a car, and shook Aasen's hand. That night, Wyoming's votes gave Kennedy the Democratic nomination for president.
Ronald Reagan, Aasen says, was even better looking than his photos. Martha and he first met him at a motel in San Mateo in 1963, after a Rotary speech. The actor invited a group to his suite. He told jokes, in a disarming way.
The Aasens saw Reagan other times too, when he promoted the "GE Theater Show."
In 1975, Aasen was in Atlanta. Jimmy Carter walked down a hotel hall, put out his hand, introduced himself and said he was running for president. He invited Aasen to a speech.
That night he spoke quietly, describing his plans for the country. Aasen thought it was too bad that such a "intelligent, decent man" might never be president. Of course, he laughs, "Carter didn't know that."
Larry and Martha Aasen, and then-1st Selectwoman Diane Farrell Goss greet President Clinton. His helicopter landed at Sherwood Island State Park.
Bill and Hillary Clinton visited Westport often, usually to meet donors. Aasen says he often forgets how tall the president is, and how he is "always in motion. He has that skill of connecting with his audience — and he will not let them go." Clinton loves to talk — "which is why he is always late."
As for Barack Obama: Once, leaving a stage, he posed for a photo with the Aasens. "Let's put the rose between the 2 thorns," Obama suggested.
President Obama and Larry Aasen flank "the rose": Martha Aasen.
Happy upcoming 95th birthday, Larry Aasen. Here's hoping you meet many more presidents — and have many more stories — in the years to come.
And this, from June of 2019 … because as much as Larry Aasen loved Westport, he never forgot his North Dakota roots.
Larry Aasen has just written his 4th book about North Dakota.
That may be a world record.
"Very few people write books about North Dakota," the Peace Garden State native and longtime Westporter says modestly.
"Then again, very few people live in North Dakota, period."
At 96 years old, Aasen still has all his wits — and his wit.
So I should note here: Very few 96-year-olds write books, period.
Aasen's oeuvre includes "North Dakota 100 Years Ago," "Images of North Dakota" and "North Dakota Postcards 1900-1930." The postcards are fascinating — some are from his parents' collection (they corresponded that way when they were courting, and lived 30 miles apart) — and so are the photos his mother took using a new-fangled camera (they were sent to Minneapolis to be developed, and arrived back 3 weeks later).
Larry Aasen has written 4 books. All focus on North Dakota.
His latest book — "North Dakotans Never Give Up" — goes beyond images, postcards and history. It's a personal memoir, weaving together Aasen's youth in the still-pioneer state with the inspiring story of residents who overcame great adversity, and achieved big things.
(Eric Sevareid, Lawrence Welk and Peggy Lee, to name 3.)
"The Depression was a terrible time," Aasen says of his youth. "Many young people in North Dakota today have no idea. There were grasshoppers, drought — you name it."
Those North Dakotans who never gave up survived by raising cows, turkeys, chickens and pigs. They made their own food. They built chairs and benches out of wood they chopped. They were self-sufficient. They had to be.
"Winters were tough," he says. "Kids really did walk to school in the snow."
He was one of those kids. And he'd go to school after milking cows. "We smelled. The town kids teased us," he recalls.
Larry Aasen's garage is filled with North Dakota — and political — memorabilia.
Aasen's grandparents were certainly tough. All 4 lived into their 80s. Their stories form an important part of the new book.
"Weak people died," Aasen says. His grandparents never went to the hospital. They didn't even have medical care.
"It cost $1 for the doctor to come to the farm. That was too expensive." He doesn't remember ever seeing medicine in the house — "except maybe cough syrup."
His mother kept a diary, which he still has. "She would talk about whatever happened that day," Aasen says. "'Today an airplane flew over the farm.' 'We butchered a pig.' 'Hoover was elected president.' There were a lot of bank robberies too."
Larry Aasen's mother's 1929 diary (left), and 2 pages from 1937.
Aasen is an assiduous researcher. He spent 9 months writing the most recent volume — and did all the layout too. (His son-in-law got it copy-ready.)
"I'm 96, but I'm too busy to be a senior citizen," Aasen — whose Mississippi-born wife Martha, 89, is equally active — says.
Aasen's books sell well — and all over the country. They're bought by libraries, universities, people who live in North Dakota, and those who have left.
They're reviewed regularly in publications like the Bismarck Tribune, Grand Forks Herald and Forum of Fargo.
Aasen promotes his books himself, partly through direct mail. After 4 volumes, he's built up a robust mailing list. (Robust by North Dakota standards, anyway.)
He used to go back every year. His trips now are less frequent.
"I had 31 cousins there. Now there's 1," Aasen says. "My classmates, my Army mates — they're all gone."
Memorial Day 2018 grand marshal Larry Aasen and his wife Martha. (Photo/Ted Horowitz)
Larry and Martha Aasen moved to Westport in 1963. They've been involved in town life — too many activities to count — ever since.
But nearly 6 decades later — after nearly a century on the planet — Larry Aasen still loves his home state. And he's proud to honor the people he grew up with there.
"A lot of people today, if they can't get a job they sit around feeling sorry for themselves," he says.
"In North Dakota, you couldn't do that. You'd starve.
"You had to be tough, and figure things out."
Like his book title says: North Dakotans Never Give Up.
Posted in Local politics, Politics, Westport life
Tagged Larry Aasen, Martha Aasen
Roundup: Justin Paul, MoCA, STAR Award, More
Posted on October 28, 2020 | Comments Off on Roundup: Justin Paul, MoCA, STAR Award, More
Justin Paul already won a Tony Award for "Dear Evan Hansen."
Now the 2003 Staples High School graduate has an Olivier too.
On Sunday, the show — which opened in London last November — earned 2 prestigious Laurence Olivier Awards. They're the British equivalent of Tonys, for plays performed there.
Paul and his writing partner Benj Pasek were honored for "Best Original Score." "Dear Evan Hansen" was also named Best New Musical.
The ceremony was originally scheduled for April, in Royal Albert Hall. After COVID, it was postponed to Sunday. Most of the ceremony was pre-taped, at the London Palladium. Click here for full details.
Justin Paul (Photo/Dan Woog)
Stress levels are high leading to Election Day. Even after voting, many residents will no doubt feel anxious.
So how about feeding your soul with some art? "World Peace" — the current exhibit at MoCA Westport, a multi-media show including photography, sculpture, video works and art that address the culture of American politics will be free, and open to the public, on Election Day (10 a.m. to 3 p.m.).
Just show your "I Voted" sticker (or mention you voted by absentee ballot). Click here for more about the exhibit.
MoCA is also hosting an Election Day workshop for children and teenagers, featuring voting-related projects related to the show. There are 2 sessions: 10 a.m. to noon, and 2-4 p.m. Click here for details.
For nearly 70 years, STAR Lighting the Way has provided services to people with intellectual and developmental disabilities, and their families.
Services include education, after-school and summer camp programs, behavioral interventions, advocacy, job training, residential support, and much, much more.
STAR is a shining light in Fairfield County. I am honored, through "06880," to spotlight so many good things the organization does.
So I was especially proud to receive this year's "Media Partner of the Year" award from STAR. The handsome glass award sits on my desk, a reminder of what a wonderful community we are all part of.
Among Martha Aasen's many passions, Martha Aasen was particularly loyal to the Westport Library.
To honor the longtime civic volunteer, who died last week at 90, the library as created a Martha Aasen Memorial Fund.
Contributions will help fund ongoing programs and projects. A plaque near the daily newspapers will honor her commitment to the community. Click here to contribute.
Martha Aasen and her husband Larry.
Brittany Berlin graduated from Staples High School in 2012, and Georgetown University 4 years later.
She began a corporate career, then began a blog to share her passion for wholesome recipes accessible to people with food allergies and specific dietary concerns. The Banana Diaries features goodies with a healthy twist.
Simon & Schuster just published her first book. Baked with Love includes over 100 allergy-friendly vegan desserts — all developed and tested by Brittany. She took all the photos too.
Click here for details and ordering information. (Hat tip: Nathalie Fonteyne)
Sure, it's another in what seems like a series of endless gray days.
But the sun shone (briefly) the other day. And Lori Lustig snapped this gorgeous reminder of why nothing — anywhere! — compares to autumn in New England:
(Photo/Lori Lustig)
And finally … in honor of Justin Paul's Olivier Award:
Comments Off on Roundup: Justin Paul, MoCA, STAR Award, More
Posted in Arts, Entertainment, Library, Media, Organizations, People
Tagged "Dear Evan Hansen", Brittany Berlin, Justin Paul, Martha Aasen, MoCA Westport, Olivier Awards, STAR Lighting the Way
Remembering Martha Aasen: The Sequel
My "06880" tribute to Martha Aasen — the long-time civic and political volunteer who died last week at 90 — mentioned many of her remarkable accomplishments.
The Mississippi native worked tirelessly for the Democratic Party, at the local, state and national levels. She founded the Y's Women, served as president of the Westport Library Board of Trustees, was a Senior Center board member, and a very active Sunrise Rotarian.
But that's like saying Mozart "wrote music."
In fact, Martha Aasen's achievements fill several pages.
Here's just a sampling.
Between 1977 and 1990, she held a number of positions with the United Nations Secretariat. They included:
Chief, non-governmental organization and institutional relations, Department of Public Information
Electoral supervisor, UN transition assistance group, Namibia
Chief, public inquiries and group program units, UN Public Services.
Previously, Martha represented the League of Women Voters of the United States at the UN. She organized the largest public meeting ever held there (1,800 people in the General Assembly).
Martha Aasen, in her professional days.
Before the UN, Martha held editorial and publishing positions with McGraw-Hill, Famous Writers Schools and Lyceum Books. She lectured at Southern Connecticut State University, and was an executive recruiter with International Executive Service Corps in Stamford.
Beyond her volunteer efforts mentioned earlier, and her political activity — for which the Democratic Women of Westport gave her a Silver Donkey Award, then named their Yellow Dog Democrat honor after her — she was a moderator and deacon of Saugatuck Congregational Church, a member of the boards of governors and directors of the United Nations Association of the United States, and part of the Mary Baldwin College alumnae board.
Decades ago, Governor William O'Neill named her an "Outstanding Woman of the Decade."
And … Martha Aasen was also a justice of the peace.
May she now rest in peace.
Posted in Library, Local politics, Organizations, People, Politics
Tagged Martha Aasen, United Nations, Westport Democratic Party
Remembering Martha Aasen
Posted on October 24, 2020 | 22 comments
Westport lost one of its most beloved residents yesterday. Martha Aasen — who with her husband Larry was a force in local and state Democratic politics for decades, but who also worked tirelessly for a variety of bipartisan civic causes — died yesterday in Norwalk Hospital of complications from a fall last weekend. She was 90 years old.
The Mississippi native and her North Dakota-born husband were a powerful pair. His politics came from the populism of the prairie; hers were sparked by President Franklin D. Roosevelt, and the injustices she saw growing up in the segregated South.
After graduating from the University of Mississippi, she worked for McGraw Hill. Her editor, Larry Aasen, became her husband. They married in 1953, and moved to Westport a decade later. They raised their children David and Susan on Ellery Lane.
Martha Aasen later worked in public relations for the United Nations, and for International Executive Service Corps in Stamford.
Her long service to the Westport Democratic Women earned her its coveted Silver Donkey Award. The Yellow Dog Democrat Award is named in her honor.She was proud of meeting a host of politicians, including Presidents Bill Clinton and Barack Obama, when they came to town.
The Westport Democratic Town Committee says:
Martha was ever-present, inspirational, and loved by all who had the honor to serve alongside her. She rarely missed an event, and always volunteered to help our candidates in any way she could.
We all learned so much from her sharing her experiences. She was a pleasure to talk to – always smiling, full of interesting stories, and offering words of wisdom and encouragement. She will be sorely missed by so many in Westport, but none more than those of us who had the opportunity to spend time with her on the DTC.
But politics was not all Martha did. She founded the Y's Women in 1990. She held numerous positions various town boards, including president of the Westport Library Board of Trustees.
She was an active member of the Senior Center, and served on the board that was responsible its recent expansion.
The Sunrise Rotary Club presented Martha with its Paul Harris Award. for "service above self."
Information on services has not yet been released.
In August 2012 — right before the Democratic National Convention — I posted this story about Martha and Larry Aasen.
In 1960, Martha Aasen was living in California. The Democratic National Convention was held in Los Angeles.
Martha came from a family of avid Democrats. Her father was a convention delegate from their native Mississippi. Her brother wangled a job as a driver for Stuart Symington, one of several men still jostling for the nomination.
Martha and her husband Larry got a room with the Mississippi delegation, in a rundown Spanish-style hotel on the outskirts of L.A. They had just checked in when another candidate appeared. It was John F. Kennedy, on his way to meet the Wyoming delegation at the same "crummy hotel."
Martha walked up to the Massachusetts senator. He took her hand, and looked straight at her. Half a century later, she remembers his "unbelievable charisma."
Kennedy's visit paid off. On the night of the roll call, Wyoming's 15 votes gave him the nomination over his closest rival, Texas senator Lyndon B. Johnson.
Though longtime Westporters Martha and Larry Aasen have been active in Democratic politics — and attending conventions — ever since, 1960 was not their first. Four years earlier, one of Larry's North Dakota Republican friends got them into the Republican convention at San Francisco's Cow Palace. They watched as President Eisenhower and Vice President Nixon were renominated.
Fannie Lou Hamer faces the Democratic credentials committee.
In 1964 the Aasens were in Atlantic City. Martha's mother was a Mississippi delegate. That year, the biracial Freedom Democratic Party challenged the seating of the state's all-white delegation. Fannie Lou Hamer gave a rousing speech. The governor urged his white delegation to walk out. Most did. Martha's mother was one of the 3 or 4 who did not.
Forty years later, in 2004, Martha was a delegate at the Boston convention. Connecticut was seated next to Mississippi. Thousands of delegates — of all races — paid tribute to the work of Fannie Lou Hamer, and other brave people who fought for civil rights.
The Boston convention also featured an electrifying keynote speech by Illinois legislator Barack Obama. "Everyone there knew we were hearing someone special," Martha recalls.
When they posed for this photo in 2016, President Obama said to Larry Aasen, "let's put the rose (Martha Aasen) between 2 thorns."
Martha was in Denver 4 years ago, when Obama was nominated for president.
She'd been back in Los Angeles in 2000, too. That was one of the few times Connecticut had good seats. They were seated right in front, next to Tennessee. The reason, of course: Al Gore's running made was Joe Lieberman.
Martha missed the 1968 Chicago convention — perhaps the most famous of all — as well as the others before 2000. She was working for the United Nations, and could not be actively involved in domestic politics.
Now 82, she looks forward to the upcoming Charlotte convention. The event has changed since the JFK days — more security, less spontaneity, and the nominee is known in advance — but they're still exciting.
"It's more of a pep rally," Martha says. "You hear speeches, and realize why you believe so strongly in what you do. You go home energized, eager to support your candidate."
And who knows? Some day, once again, a candidate may come calling on Connecticut. Just as John F. Kennedy did with Wyoming back when he needed a few more votes, wherever they were.
Larry and Martha Aasen, and then-1st Selectwoman Diane Farrell Goss greeted then- President Clinton. His helicopter landed at Sherwood Island State Park.
Posted in Local politics, People, Politics
Tagged Democratic Women of Westport, Larry Aasen, Martha Aasen, President Barack Obama, President Bill Clinton, Westport Democratic Party
Larry Aasen: "North Dakotans Never Give Up"
(To buy a copy of Aasen's book, email aasenm@aol.com, or call 203-227-6126.)
Posted in History, Media, People
Tagged "North Dakotans Never Give Up", Larry Aasen, Martha Aasen, North Dakota
Senior Center: An "Old" Home Is Now Very New
Martha Aasen remembers when Westport's Senior Center was part of Staples High School.
Two small rooms were hidden between the fieldhouse and wood shop. It was open just a few hours a day. Lunch came from the school cafeteria.
In 2003, a new Senior Center opened on Imperial Avenue. It was a spectacular improvement.
Bright and airy, it was filled with rooms for meetings, lectures, fitness and films. There was a library and dining room too. Seniors flocked there for events, classes and camaraderie.
That was 15 years ago. When First Selectman Jim Marpe cuts a ribbon tomorrow (Friday, January 4, 11 a.m.), Westporters of all ages will marvel at the first major enhancement of the Senior Center since it opened.
The 9-month project comes in on schedule — and on budget. The town appropriated $3.975 million. Friends of the Senior Center raised $300,000 for equipment and amenities.
(Clockwise from lower left): Martha Aasen, Leslie Wolf, Stan Nayer and Sue Pfister in the lobby of the newly modernized Senior Center.
Last week, Senior Center director Sue Pfister, Friends president Leslie Wolf, and Aasen — now in her 90s, and as passionate about the Center as ever — offered a tour of the new facility. It blends seamlessly with the original.
The 5,000-square foot new wing includes:
A new fitness center, with modern treadmills and machines
A strength classroom, also used for tap dancing and Zumba
A new library, with a computer and magnifiers
A drop-in game room
All new furniture and carpeting
New display cases for artwork
Outdoor access to the adjacent Baron's South meadow, for tai chi and meditation
Offices for program manager Holly Betts, and interns
New restrooms with showers (for when the Senior Center is used as an emergency shelter).
Martha Aasen on the new treadmill. Doors open onto the Baron's South park.
Other parts of the Senior Center have been modernized too. There are new floors, chairs and tabletops in the "Sue's Cafe" dining room (where "grab-and-go" food will soon be available); a new wood floor next door, for dance classes; a second art room, and a handsome new custom desk in the entry foyer.
"It's even better than we envisioned," says Aasen — who was closely involved in the project — proudly.
"We've had so many meetings, and we saw all the plans. But when you actually see it finished, it's unbelievable."
"Stunning!" adds Pfister.
New windows provide the same airy look as the original wing of the Senior Center.
The Senior Center director credits the project's smooth completion to "tremendous cooperation" from local officials. The Building Department's Steve Smith, the Department of Public Works, and Parks & Recreation director Jen Fava were all all-in.
Architect Brian Scheuzger designed the original building too. A.P. Construction — which is also handling the Westport Library's Transformation Project — did all the work.
The Senior Center attracts a wide range of people, Pfister notes: Those who are very active; those looking for quiet activities; those who want to meet old friends, and those seeking companionship.
It's a welcoming facility for some, a second home for others.
Now — for all of them — Westport's Senior Center is better than ever.
Workers were still finishing up — and unloading furniture — last week.
Posted in Local politics, Organizations, People, Places
Tagged Friends of the Westport Senior Center, Leslie Wolf, Martha Aasen, Sue Pfister, Westport Senior
Larry Aasen Leads Memorial Day Parade
Posted on May 14, 2018 | 11 comments
Posted in History, People, Westport life
Tagged Larry Aasen, Martha Aasen, Westport Memorial Day parade, World War II veterans
Larry Aasen: 95 Years, 6 Presidents, Bob Hope And Muhammad Ali
Posted on October 8, 2017 | 17 comments
Posted in People, Politics
Senior Center: Town Jewel Seeks Enhancements
There are about as many senior citizens in Westport as school-age children.
But you can't lump all our older folks together, any more than you can say kindergartners are the same as, um, seniors.
The men and women who frequent our Senior Center — formally known as the Westport Center for Senior Activities — range in age from 60s to 90s. Some come nearly every day; others regularly, or infrequently.
They head to the handsome downtown building for a variety of reasons: Fitness, aerobics, Pilates or yoga. Discussions and lectures. Meet longtime friends, and make new ones. Parkinson's support groups. Lunch. Use computers. Play pool, bridge, poker, Scrabble or ping pong. Paint, sculpt or sketch. Read. Help with taxes, financial planning or Medicare options. Parties. Movies. Blood pressure screening or flu shots. Find companionship, and a community.
A Senior Center lecture draws a typical full house.
Our Senior Center is one of the most popular, well organized and best staffed in the country. But growth — up to 350 people a day — has created a critical need for enhancements.
In 2007, town planners predicted the Imperial Avenue center would run out of space in 2011. The recession forced improvements onto the back burner.
For the past 7 years, they've been part of the 5-year capital forecast. On Wednesday, May 17 (8 p.m., Town Hall), Senior Center representatives will ask for $3.9 million for enhancements.
Plans for the enhanced Senior Center. Click on or hover over to enlarge.
The Senior Center — run under the umbrella of the Human Services Department — has been around since the mid-1980s. Originally one room in the YMCA's Bedford Building, it expanded when Greens Farms Elementary School closed (space there was shared with the Westport Arts Center).
When Greens Farms reopened, the Senior Center moved to a couple of rooms at Staples High School. The Imperial Avenue facility — built with strong support from First Selectman Dianne Farrell — opened in 2004. ("Ahead of schedule and under budget," director Sue Pfister notes with pride.)
Much has changed since then. Closing hours were lengthened and Saturdays added, to accommodate seniors who still work.
Westport's 60-plus population has risen dramatically — and they're living longer.
As the Senior Center expanded its programming, more men and women attended more often.
There's no more room for some activities. Four times a year, when registration opens for popular classes like yoga (gentle, regular and intense levels), the line forms at 6:30 a.m.
The small fitness area was filled to capacity on Saturday morning.
The other day, Pfister joined Enhancement Committee chair Lynn Goldberg and member Martha Aasen to explain the $3.9 million request.
There are 3 prongs.
One involves adding 4,500 square feet, offering:
More room for existing and new programs.
Space to socialize. "Many people meet friends here; they don't go to each other's homes nowadays," Pfister says.
Meals to go (the Center serves 11,000 lunches a year — but for some seniors it's their only real meal of the day).
Flexibility to adapt to changing future needs. "There's a whole group of 'new elders' coming down the line," 87-year-old Aasen notes.
(From left): Martha Aasen, Lynn Goldberg and Sue Pfister. Fitness equipment is stored in the hallway, because there's no room anywhere else.
The 2nd element is parking and transportation. "If people can't get here, our great programs are worthless," Goldberg notes. For popular events, people now park as far away as Colonial Green.
"Senior-friendly" enhancements include more spots closer to the entrance, eliminating inclines, and adding ramps.
The 3rd category is "building tweaks." This includes flashing work, making the front doors easier to use, adapting the computer room to the increase in laptops, and repositioning the fitness room so it opens onto walking trails on Baron's South. (Parks and Recreation director Jen Fava is a member of the Enhancement Committee.)
A rendering of the proposed Senior Center building.
The Senior Center is a Westport jewel. And it's not just for seniors.
Pfister is a huge proponent of intergenerational activities. Staples students volunteer there (one particularly popular activity: iPhone and iPad training). STAR delivers meals. The Senior Center often partners with the Library and other town organizations to sponsor programs.
"Mixing generations together helps reduce cognitive decline," Pfister says. "And younger people get a lot out of interacting with older ones."
A young volunteer at the annual lobster/clambake. The Senior Center serves 11,000 meals a year. For some, it's their only real meal of the day. The proposed enhancement would enable the addition of "grab-and-go" meals.
She is excited about a new, upcoming activity. Suzuki has offered to run a course. Pfister must decide between violin or voice lessons.
Why not both? I ask.
"There's no room," she says.
Not now, anyway.
Posted in Local politics, Organizations, People
Tagged Lynn Goldberg, Martha Aasen, Sue Pfister, Westport Center for Senior Activities, Westport Senior Center
Bill Clinton Comes To Town
As president, Bill Clinton visited Westport 3 times — all for fundraisers.
He was back again last night. This time he raised cash on behalf of someone he hopes will be another President Clinton: his wife Hillary.
Attendees paid up to $2,700 for the event, at the Beachside Avenue home of hedge fund manager/Milwaukee Bucks co-owner Marc Lasry.
Press coverage was not allowed. Attendees said Clinton spent half an hour making a spirited case for his wife's election, then chatted with guests for another half hour.
President Clinton with longtime Democratic activists Lee Greenberg and Martha Aasen.
President Clinton and Senator Richard Blumenthal have been friends for many years.
President Clinton with RTM member Kristan Peters-Hamlin. Her husband is related to Abraham Lincoln's first vice president, Hannibal Hamlin.
Tagged Bill Clinton, Hillary Clinton, Kristan Peters-Hamlin, Lee Greenberg, Martha Aasen


Parkowe Wzgórze (Park Hill) is an exclusive housing development located to the south of Kraków. It is situated on a rise in the area of Mogilany, a beautiful southern town close to Krakow with views of the Tatra mountains to the South and a panorama of the city of Kraków to the north. In the immediate vicinity of the housing estate are schools, shops and other services. The centre of Krakow can be reached by car in approximately 30 minutes via the main southern arterial road, ul. Zakopianska. The development is popular with expatriate families as it is close to the International School in Lusina. Park Hill is being completed in three stages of construction. The first two stages are already completed, and the third stage went on sale in 2011. There are both detached and semi-detached houses available, ranging in size from 140m2 to approx 300m2. Contact Hamilton May to enquire about our current rental offer in Park Hill.


text:
/* TODO: figure out how to make the top of this the bottom of the nav bar */
.heading {
  background-color: white;
  font-size: 20px;
  position: fixed;
  top: 90px;
  width: 100%;
  z-index: 1;
}

ul {
  list-style: none;
}

.touched {
  background-color: beige;
}

redpajama_set_name: RedPajamaGithub


Feeling a need to take your time this morning? That's lucky! We have rolled out a sweet and savory offering for you in our establishments. So, where are you having brunch then? The Monte-Carlo Bay Hotel & Resort, the Hôtel Hermitage Monte-Carlo, the Monte-Carlo Beach or somewhere else? Make way for sparkling breakfasts and tasty brunches that make you smile. Here's a rundown of the options.
Hôtel Hermitage Monte-Carlo… Whether you're just passing through or a regular, you can enjoy a unique setting and choice table in two dedicated areas. On the mezzanine under the cupola or out on the terrace to enjoy the view and at the Le Limùn restaurant with its regularly changing decor... Your every desire is catered to here!
Café de Paris Monte-Carlo… During breakfast between 8 and 11 am, a relaxed yet chic brasserie ambiance brings the place to life. Offered à la carte or as a set menu, it will be a big hit with fans of continental breakfasts in particular.
Mada One... For those who want to visit Monaco and don't want to miss out on a delicious early-morning layover. Here, breakfast is an art! In this temple of "snackonomy", a concept invented by the chef Marcel Ravin, guests' palates are gently woken up each morning by four set menus: "Continental", "American", "Healthy" and "Asian". There is enough variety to satisfy fans of savory, sweet and wellness foods.
On the seventh day, shall we relax over brunch in Monaco?
Monte-Carlo Beach… A crystalline pool, a sea view, healthy food and a summery atmosphere inviting leisurely relaxation... The Sunday brunches organized by the Le Deck restaurant make good on this promise between June and mid-September. This friendly and refined buffet lunch gives pride of place to the new gastronomic trends extolled by Michelin-starred chef Paolo Sari, who handpicks the producers of the various ingredients served there every Sunday. The decor and menus help to transform these days of rest into special occasions.
Las Brisas… From June to September, head to Las Brisas to discover how Marcel Ravin adapts his talents to summer dishes. The head chef has even more surprises, colors and flavors in store, so you can enjoy this festive and gourmet occasion, starting sunny days the right way. This year, a strolling live band plays acoustic versions of the classics, for summer Sundays providing welcome relaxation.
Hôtel Hermitage Monte-Carlo… This is the quintessential "chic" brunch! On the Eiffel mezzanine, every Sunday until April 14th, chef Benoît Witz combines the aroma of champagne with a hearty buffet, complete with live cooking stations. To be enjoyed with friends or family, with a kids area and playroom for children.