Vision Care
Section Newsletter
Fall 2004

Message from the Chair

The Vision Care Section (VCS) of APHA is completing a landmark year of accomplishments, in celebration of our Silver Anniversary as a section. The anniversary coincided with a major milestone joint meeting of the World Congress on Optometric Globalization and the American Optometric Association. The World Council of Optometry is officially a task force member of the World Health Organization and will contribute to a global strategy to prevent avoidable blindness as part of the VISION 2020 mission: The Right to Sight. The Vision Care Section was also acknowledged and received strong support from the House of Delegates at the AOA annual meeting.

It is exciting to have optometry involved with public health issues at the local, state, nationwide and now, international levels. The most rewarding aspect of this involvement is the fact that we are crossing organizational disciplines to optimize service to the broadest population of needy recipients. There are no boundaries to a mission that incorporates common good, and VCS is part of that mission.

The success and growth of the section could never have been accomplished without the dedication and hard work of our volunteer members. These individuals envisioned and made the section what it is today. They are involved in important section activities, and they are visible as major contributors to the Executive Council of APHA. Now we have expanded optometry’s involvement in world health issues. What better time to have a Chair-Elect with “world vision.” Dr. Berger was part of a group that organized a conference on “Affordable Vision Correction” (see details in this newsletter). This conference explored prospects for implementing vision correction strategies that were in line with the current World Health Organization Global Initiative, Vision 2020.

It seems that we have truly reached a milestone in our silver anniversary year. We have brought the dreams and goals of the early organizational planners of the VCS to a world forum, and through this effort each member of the section and the world family of optometry has paid them and our profession a very special honor. Thank you all for the roles you have played in making this wonderful union of events possible. Now our goal is to maintain our enthusiasm and make it contagious to students and practicing eye care professionals in a manner that promotes continued contributions and growth of all of our public health efforts.

Vision Care Section Elects New Officers

The Vision Care Section is pleased to announce the newly elected officers as follows:

Chair-Elect:
Norman Bailey, OD, MBA, MPH

Secretary:
Wende Wu, OD, MPH, MS

Governing Council:
Debbie Hettler-Albeitman, OD, MPH

Section Councilors:
Sandra Block, OD, MEd
Jerry Vincint, OD, MPH

CONGRATULATIONS!

APHA Anual Meeting 2004

The APHA Annual Meeting will be held November 7-10 in Washington, D.C. Below is the schedule of the Section's business meetings. Everyone is encouraged to attend. All Vision Care meetings and sponsored scientific sessions will be held in the Renaissance Hotel, which is conveniently located near the convention center. Book your hotel now to assure that you get your first choice.

VISION CARE SECTION BUSINESS MEETINGS:

SUNDAY, NOV. 7, 2004: 2:00 p.m.-3:30 p.m.
Renaissance
Meeting Room 7
(240.0) Vision Care Section Business Meeting
Sponsor: Vision Care Section

SUNDAY, NOV. 7, 2004: 4:00 p.m.-5:30 p.m.
Renaissance
Meeting Room 15
(276.0) Vision Care Section Business Meeting 2
Sponsor: Vision Care Section

MONDAY, NOV. 8, 2004: 6:30 p.m.-8:30 p.m.
Renaissance
Meeting Room 15
(362.0) Vision Care Section Business Meeting 3
Sponsor: Vision Care Section

TUESDAY, NOV. 9, 2004: 7:00 a.m.-9:00 a.m.
Renaissance
Room TBD
Eye Opener Breakfast

TUESDAY, NOV. 9, 2004: 6:30 p.m.-8:00 p.m.
Renaissance
Meeting Room 7
(454.0) Vision Care Section Business Meeting 4
Sponsor: Vision Care Section

Vision Care Section Annual Meeting Scientific Program

MONDAY, NOV. 8, 2004: 8:30 a.m.-10:00 a.m.

Renaissance
Meeting Room 12
(3087.0) Current Issues in Vision Care and Oral Health (organized jointly by VC and OH)
Sponsor: Vision Care Section
CE credits: CH, RN
D. Hettler, OD MPH FAAO, Moderator

8:30 a.m. — (94934)Kids and contact lenses. J. J. Walline, OD, PhD

8:48 a.m. — (77594)Optometric Workforce Databases. M. Soroka, PhD; T. Crump, MPA; A. Bennett, MPA

9:06 a.m. — (85332)PC-Based Visual Function Tests: A Novel Method of Follow-up in Longitudinal Studies. H. Bahrami, MD, MPH; M. Melia, PhD; G. Dagnelie, PhD

9:24 a.m. — (79389)Move over Tinkerbell, there's a new fairy in town. M. H. McClean, RDH; K. D. Wyche, MD, MPH; M. P. Vaughan, DDS

9:42 a.m. — (84360)School based fluoride varnish program: Effect on participation rates. H. K. Singh, RDH, MS; C. S. Culler, RDH, MPH; M. Henshaw, DMD,MPH

MONDAY, NOV. 8, 2004: 12:30 p.m.-2:00 p.m.

Renaissance
Meeting Room 12
(3238.0) International Eye Care
Sponsor: Vision Care Section
CE credits: CH, RN
E. M. Gable, OD, FAAO, Moderator

12:30 p.m. — (84251)Burden Among Male and Female Unoperated Trichiasis Patients in Two Trachoma Endemic Districts in Tanzania. K. D. Frick, PhD; A. J. Sanyiwa, MD, MMed; E. M. Ngirwamungu, MD,MPH; G. A. Jacobson, MS; R. Buhrmann, MD, MPH, PhD; P. Kilima, MD, MSc

12:48 p.m. — (75814)Implementation of the SAFE strategy for trachoma prevention may have enhanced success in Muslim populations if the familiar language of ablution is adopted. S. B. Syed, MBBS DPH DFPH; M. Muhtaseb, BSc MBBS MRCOpth

1:06 p.m. — (79957)UNESCO Observatory of Visual Health Services--Central America. J. Leasher, OD, MPH

1:24 p.m. — (85241)High prevalence of cataracts and pterygium in rural Salvadoran patients presenting at a temporary health clinic. E. I. Peralta Orellana, Optometrist; J. Obedin-Maliver; M. L. Cremer, MD, MPH

1:42 p.m. — (85230)Unite For Sight: An International Network of Students Working To Improve Eye Health Outcomes. J. B. Staple
The Eye Opener Breakfast followed by the VCS Awards is Tuesday, Nov 9 from
7:00- 9:00 a.m.

TUESDAY, NOV. 9, 2004: 8:30 a.m.-10:00 a.m.

Renaissance
Meeting Room 4
(4084.0) New Horizons in Vision Screening and Testing
Sponsor: Vision Care Section
CE credits: CH, RN
J. J. Walline, OD, PhD, Moderator

8:30 a.m. — (95018)Vision In Preschoolers (VIP) Study: Overview and Results - Phase I. L. A. Cyert, PhD,OD

8:48 a.m. — (80495)Impact of a population-based vision screening program on spectacle wear among Native American children. C. E. Clifford, BA; J. M. Miller, MD, MPH; E. M. Harvey, PhD; V. Dobson, PhD

9:06 a.m. — (93701)Pennsylvania College of Optometry (PCO) and The School District of Philadelphia (SDP): A partnership to meet the vision care needs of the public school children of Philadelphia. S. Oleszewski, OD, MA

9:24 a.m. — (84417)Findings from a Pilot Eye Screening Program for Hispanic Migrant Farm Workers in Illinois. A. J. Berman, MD; L. S. Forst, MD, MPH, MS

9:42 a.m. — (81563)Glaucoma Screening in Medicare+Choice Health Plans. P. Renner, MBA; L. Wong, MHS; R. Mardon, PhD; P. Gwet, PhD

TUESDAY, NOV. 9, 2004: 12:30 p.m.-2:00 p.m.

Renaissance
Meeting Room 4
(4176.0) Teaching Public Health to the Health Care Professions (organized jointly by VC, CHC, PHC)
Sponsor: Vision Care Section
CE credits: CH, RN
S. S. Block, OD, Moderator

12:30 p.m. — (78314)Curriculum reform in the health promotion course at a chiropractic college: Are we making progress towards improving clinical relevance?. C. Borody, BSc DC; H. Till, MSc, MMedEd

12:48 p.m. — (79089)Putting "healthcare" and "choice" into chiropractic public health education. L. Killinger, DC; I. N. Paulavicius, MA

1:06 p.m. — (80216)SightCare: Educating Caregivers about Vision Loss. B. Litke, MA; C. Wirts, MS

1:24 p.m. — (84833)Public health approaches in addressing refractive errors. J. Vincent, OD MPH

1:42 PM — (84148)Nutritional patterns among eye care patients. P. Heyn, PhD; R. Tang, MD,MPH; M. Raji, MD; S. Owen, PhD

WEDNESDAY, NOV. 10, 2004: 12:30 p.m.-2:00 p.m.

Renaissance
Meeting Room 15
(5143.0) Addressing Healthy People 2010 Objectives: Vision Care, Chiropractic Health Care and Podiatric Health Care (organized jointly by VC, CHC, PHC)
Sponsor: Vision Care Section
CE credits: CH, RN
Norma K. Bowyer [bowyer@earthlink.net], OD, Discussant, Moderator

12:30 p.m. — (82751)Reducing Vision Impairment For Selected Vision Objectives of Healthy People 2010. R. N. Bailey, OD, MBA, MPH

12:48 p.m. — (85206)Addressing Healthy People 2010 Vision Objectives in an education clinical setting. E. M. Gable, OD, FAAO

1:06 p.m. — (77727)An assessment of the awareness and attitudes of faculty at chiropractic colleges toward the Healthy People 2010 initiative. G. M. Pearson, MBBS,BSc; C. Hawk, DC, PhD; L. Killinger, DC; P. J. Robinson, MA

1:24 p.m. — (76152)Development of a smoking cessation protocol for use in chiropractic offices. C. Hawk, DC, PhD; A. Odhwani, MD, MPH; K. Thomas, DC

ADDITIONAL VISION ABSTRACTS/SESSIONS OF INTEREST

TUESDAY, NOV. 9, 2004: 2:30 p.m.-4:00 p.m.
Location TBD
(4230.0) Healthy Aging (organized jointly by Podiatry, Chiropractic Health Care and Vision Care)
Sponsor: Podiatric Health Section

2:30 p.m. Quality of Life and Perception of visual Impairment Among Elders in a General Ophthalmology Clinic Rosa Tang, MD, MPH, Patricia Heyn, PhD, Steven Owen, PhD, Mukaila Raji, MD

3:05 p.m. Elders' Right to Sight Project: A New Model of Eye Care Delivery for the Elderly Y.K. Gary Chu, OD, MPH, Jennifer Kaldenberg, OTR/L, MSA

3:25 p.m. Influence of eye disease and vision disorders on hospital use, length of stay, and hospital charges Alan R. Morse, PhD, Raymond R. Aarons, DrPH, Elaine S. Yatzkan, PhD

TUESDAY, NOV. 9, 2004: 4:30 p.m.-6:00 p.m.
Location TBD
(4258.0) Community-Based Research of Racial and Ethnic Disparities in Health: Guiding Policy and Practice
Sponsor: Community Health Planning and Policy Development

4:45 p.m. National Eye Institute Community Award Project: Meeting Healthy Vision 2010 objectives in partnership with community health centers Roger Wilson, OD

Visit the Vision Care Section Exhibit Hall Booth at the Annual Meeting

Once again this year at the Annual Meeting the VCS will be visible in the exhibit hall. We will be a part of the award winning Mega-Booth. For the past two years Oral Health, Podiatric Health, Chiropractic Health and Vision Care have won ribbons for the Best Section Booth. We expect nothing less this year. Our four sections have a common character, size, and spirit among APHA's many sections, and we use our combined strength to outclass the other, larger sections in booth presentation.

This year the Annual Meeting theme is "Public Health and the Enviroment." The booth will be highlighting four eye-related issues with small poster presentations; Cataracts, Macular Degeneration, Occupational Eye Safety and Eye Safety in Sports. In addition, we will have information available on other eye diseases, conditions, and current eye care procedures. But, best of all, the booth will be staffed by a top-notch team of eye care professionals ready to help and inform the exhibit hall's thousands of visitors about the importance of proper eye care. This is an opportunity to bring to the other health care professionals attending the meeting an increased understanding of how eye care relates to them and their professions.

We encourage everyone to stop by the Mega-Booth and catch the spirit.

Walk the Hill for Public Health on Nov. 9

On Nov. 9, 2004, during APHA's 132nd Annual Meeting, you are invited to a public health rally and to walk the halls of Capitol Hill with thousands of other public health professionals to advocate in support of public health. To learn more about the logistics of the Hill Day and how to register as a participant, visit <www.apha.org/legislative/walkhill/index.htm>.

Membership Update

Mebership Chairman Morton Silverman, OD, is continuing to work on new and inovative ways to increase our membership. Currently, the section is soliciting the support and cooperation of the AOA and Executive Directors of State Associations to improve our strength and numbers. To date we are 390 members strong. We encourage all who read our newsletter to become an active participant in our section.

Section Announces Award Receipients

The Vision Care Section announced its award receipients during the mid-year meeting in June. The awards will be presented at the Vision Care Section's Eye Opener Breakfast, held at the APHA Annual Meeting in Washington, on TUESDAY, NOV. 9, from 7:00 a.m.-9:00 a.m. at the Renaissance Hotel.

The distinguished service award will be presented to Dr. Lorraine H. Marchi. Marchi is the founder of the National Association for Visually handicapped (NAVH). Under her leadership, the NAVH has helped millions to lead independent, productive and beneficial lives over the past 50 Years.

A special recognition Award will be presented to the family of th Late Dr. Terry Ingraham for his lifetime of devotion to our section and the organization.

The student paper project award, which is now Betta Sigma Kappa - Vision Care Section award, will be given to
Bharti Bathija, Kathy Gaynor, Josephine Mew, Angela Tardanico, and Rita Vijh, for their paper "Diabetes and Optometric Care."

First Conference on Affordable Vision Corrrection

Clarendon Laboratory at the Department of Physics was the venue for the first international conference on affordable vision correction, held from Aug. 7-9, 2004 at the University of Oxford. Financially supported by the Spectacle Lens Group of Johnson & Johnson Vision Care, Inc., 31 participants from 11 countries (Nigeria, India, the United States, the United Kingdom, Australia, Tanzania, South Africa, Switzerland, Spain, Thailand and New Zealand) provided perspectives in reaction to the enormous challenge of vision care for at least one billion people, mainly in developing countries, who currently have little or no access to refractive examinations or refractive correction devices. The meeting and program were planned by a committee comprised of Professor Joshua Silver from the University of Oxford and Adaptive Eyecare; Dr. Ian Berger from the InFOCUS Center for Primary Eye Care Development; Dr. Amitava Gupta from Johnson & Johnson; and Maria Jesus Laguna, an attorney from Spain, who served as the conference organizer in Oxford. With several innovative refractive correction approaches presented, prospects for implementing vision correction strategies under the current World Health Organization Global Initiative, Vision 2020, look hopeful.

Professor Norman Bailey from the University of Houston College of Optometry set the tone for the conference by reminding the group of ethical issues concerning delivery of vision care to poor and disadvantaged countries, and then Drs. Faustina Idu and Uduak Udom of the University of Benin (Nigeria) and the Nigerian Optometrists' Association emphasized that vision correction, if made available and affordable in poor countries, will significantly impact positively on the quality of life by reducing poverty and preventing social exclusion. Dr. Dan Sheni (South Africa), current President of the World Council of Optometry, gave guidelines on the cost of affordable eye wear, that it should not be more than 0.1 of the average monthly income of the target population. Significant innovations that would enable such financial access were presented by Joshua Silver and Michael Wills (Adaptive Eyecare, Ltd.), who are promoting "self-refraction" with AdSPECS; Graham Macmillan, USA, Director of the Scojo Foundation suggesting a first challenge with presbyopia; and David Dunaway, executive director of InFOCUS who described the process of manufacturing mould injected acrylic ophthalmic lenses for Instant Eyeglasses. The possibility of affordable astigmatic spectacle lenses was given a huge boost with the demonstration of surface deformation and rotation of lens pairs presented by Professor William Harris and Anthony Carlson from Rand Afrikaans University, South Africa.

Dr. Kavita Mistry (InFOCUS) reviewed the worldwide distribution of refractive errors and said that sufficient data are currently unavailable to predict conditions for previously unexamined specific local populations, concluding that flexibility and availability of essentially all corrective prescriptions must be anticipated for any given population. Ajeet Bhardwaj (India) discussed in detail the complexities of eye care for populations like those of rural India. For instance, how 50 percent of those in need of vision correction are not even aware of the potential benefits from refractive error correction.

Work in progress in providing care was reviewed by Professor Valerian Lyimo, Tanzania, vice-principal of the Tumaini University School of Optometry, presenting a breakdown of available resources in a country like Tanzania. Professor Alabi Oduntan, South Africa, University of the North School of Optometry, reviewed the special cases of South African children with oculo-cutaneous albinism who have significant refractive errors and how critical affordable correction is needed for such populations. Dr. Jerry Vincent (Thailand) of the International Rescue Committee described how refugee health workers have been trained to conduct subjective refractions and dispense spherical lenses as needed.

Dr. Helen Roberts, UK, from The Partnership for Child Developmen,t presented how education and school health resources were combined in Zambia and will soon be in Eritrea, to include vision as well as health care.

Dr. Harry Zeltzer, USA, Executive Director of VOSH, International, described how professional eye care providers are able to provide not only direct care to needy populations, but also to stimulate resource development for improved access to vision care.

From the perspective of a major provider such as the UK Aid for International Development, Julian Lambert, a divisional director, reminded conference participants that any new and innovative approach must be marketed to and accepted by those in need, and that "affordability" implies stimulating a demand. Vision care is a critical need, but its provision depends not only on technical and strategic innovation to enable feasibility, but on its acceptance and appreciated value, as well, to insure its sustainability and development.

Further meetings on affordable vision care are being planned, and proceedings from this first conference are expected to be published. Look for announcements at <www.affordable-vision-correction.org> or <www.infocusonline.org>.

Number of Rural Uninsured Continues to Rise

(Washington, D.C.) -- The National Rural Health Association called on lawmakers to act now to address the rising number of uninsured Americans. The Association expressed great concern regarding statistics released by the U.S. Census Bureau, showing America's uninsured population rising to 45 million people. The increase represents an alarming 3.2 percent increase in uninsured Americans between 2002 and 2003. This rise in the number of uninsured Americans is particularly alarming for those who live in rural communities, because rural Americans are more likely to be uninsured and are less likely to have employer-sponsored coverage.

According to a March 2004 NRHA Policy Brief (which utilizes statistics from numbers based on the Medical Expenditure Panel Survey), rural Americans have an uninsured rate about 6 percent higher than urban Americans. This is because rural Americans have an employer-sponsored coverage rate that is 11.5 percent lower than the urban rate. Rural Americans are also about twice as likely to work for a low-wage employer. Low-wage workers receive health coverage 32 percent of the time, while 77 percent of other workers are offered coverage.

According to the U.S. Census Bureau, the increase in the rate of uninsured Americans from 15.2 percent to 15.6 percent is largely due to a decline in employer-sponsored coverage. The percentage of Americans who are covered by their employers fell to 60.4 percent in 2003 from 61.3 percent in 2002. For rural Americans this represents a further decline in coverage source that is already disturbingly weak.

"To those of us in the health-care field, and even to those of us who aren't, these statistics should be a real wake-up call for the need to address this country's uninsured population," NRHA Executive Director Stephen D. Wilhide said. "Rural Americans, in particular, are in need of real solutions. We cannot allow the current negative trend in health insurance coverage to continue unabated."

For more information on access to health insurance in rural America, see the NRHA Policy Brief at
<www.nrharural.org/dc/policybriefs/insurance.pdf>.

The NRHA is a national nonprofit membership organization that provides leadership on rural health issues. The association's mission is to improve the health and well being of rural Americans and to provide leadership on rural health issues through advocacy, communications, education and research. The NRHA membership is made up of a diverse collection of individuals and organizations, all of whom share the common bond of an interest in rural health.

At American Optometric Association Congress this year in Orlando, the AOA House of Delegates passed a resolution supporting NRHA and their local state affiliates. The AOA encouaged its members to join NRHA at state or national level. If you are interested in becoming a member, check out <www.NRHArural.org>.

Wold Council of Optometry Passes Resolution in Orlando

The World Council of Optometry (WCO) recently entered into official relations as a task force member of the World Health Organization's global strategy to prevent avoidable blindness, VISION 2020: The Right to Sight.

At the WCO World Congress on Optometric Globalization held in Orlando in conjunction with the American Optometric Association annual meeting, the General Delegates of the WCO passed a resolution recommending all optometry educational and training programs include public health and community health. Attached is the resolution. Dr. Janet Leasher was named co-chair of the WCO Public Health and Development committee.

RESOLUTION
WORLD COUNCIL OF OPTOMETRY
PASSED JUNE 24, 2004, IN ORLANDO, FLORIDA, USA

WHEREAS, it is critical for the profession of optometry to convey, in the public interest, its fundamental role in and commitment to the principles of public and community health; and

WHEREAS, all of the advanced professions involved in human services delivery include in their curricular preparation, both didactic and applied, the principles and practice of public and community health; and

WHEREAS, the World Health Organization, The World Federation of Public Health Associations and all other major national and international associations and organizations of health and human services professions and disciplines strongly endorse the study of public and community health and of its epidemiological constructs; now, therefore,

BE IT RESOLVED, that the World Council of Optometry reaffirms its commitment to the world-wide enhancement of eye health and visual efficiency; and

BE IT FURTHER RESOLVED, that the World Council of Optometry records itself and urges its member organizations and institutions to emphasize public and community eye health in all optometric education and training.

For more information on VISION 2020, see the IAPB Web site: <www.v2020.org>.

Alzheimer’s Disease and the Visual Pathway

 
Dr. Valenti and collegues presented a poster at the recent International Alzheimer's Association Meeting. For more information on the meeting and Association, visit <www.alz.org>.

ALZHEIMER’S DISEASE AND THE VISUAL PATHWAY
Denise A. Valenti, OD
Thomas M. Laudate, MA
Alice Cronin-Golomb, PhD

Alzheimer’s disease (AD) impacts visual functions early in the course of the disease and functional losses correlate with cognitive losses. Tissue changes in the brain manifest themselves as senile hyaline plaques and neurofibrillary tangles. Such changes in the visual system have been documented in numerous areas of the brain including the lateral geniculate nucleus.

Glaucoma, another neurodegenerative disease, impacts many of the same visual functions affected by AD and damages the lateral geniculate nucleus. When patients with AD also have glaucoma, the course of vision loss related to glaucoma is much more rapid and aggressive than in people with glaucoma, but without AD. Glaucoma affects visual function at the initial site of neural activity, the retinal ganglion cells, and ultimately destroys their afferent axons at the nerve fiber layer in the retina. AD, on the other hand, impacts cells that may be considered terminal or intermediary in the visual pathway in the brain itself. The impact is also loss of nerve fiber connections and probable further atrophy along the visual pathway, again resulting from the elimination of neuronal input.

Both diseases have been shown to have significant impact on the lateral geniculate nucleus. When the two diseases exist in a single individual, the effect is greater destruction of the visual system. AD and glaucoma impact the same visual pathways, but start at different points. When the two occur simultaneously, the loss of neuronal structures is cumulative and the functional loss of vision is greater. Measuring the subtle changes early on in the visual system is complex in AD because of reductions in cognition. Optical Coherence Tomography (OCT), which requires minimal cognition, utilizes light waves, much the same way ultrasound uses sound waves, to measure the retinal structures and has extensive application in the diagnosis and management of glaucoma. Frequency Doubling Technology (FDT) uses sinusoidal gratings combined with flicker frequency to test the central twenty degrees of vision and it also is widely used in glaucoma. The preliminary findings with OCT and FDT in a group of individuals with AD will be presented.

Unite for Sight Symposium Global Partners

Saturday, Oct. 2, 2004
Symposium 12-4:30 p.m. ET at NYU School of Medicine
Followed by Jazz For Peace Festival at 5:30 p.m.
New York City

Register at <www.uniteforsight.org/2004_symposium.shtml>
Contact <JStaple@uniteforsight.org> with any questions.

Robert Wood Johnson Community Health Leadership Program

Each year, the Robert Wood Johnson Community Health Leadership Program (CHLP) honors 10 outstanding individuals who overcome daunting odds to expand access to health care and social services to underserved and isolated populations in communities across the United States. Each is awarded $120,000: $105,000 for program support and $15,000 as a personal stipend.

"We welcome nominations from consumers, community leaders, health professionals, government officials and others who have been personally inspired by people providing essential community health services. We regret that nominations from development and public relations departments or professional grant writers cannot be accepted.

"Our nomination process begins with a Letter of Intent (LOI). The LOI can be sent to the Community Health Leadership Program (CHLP) at any time during the year but is due no later than September 22.

"Nominators of selected candidates will receive full nomination packages. Completed nominations are due in our office by Nov. 10."

For more information, visit <www.communityhealthleaders.org/index1.cfm>.