To attract and support the best employees in a competitive job market
Survey after peer has shown that after monetary compensation, employees value health insurance benefits over any other aspect of their job. Group health insurance benefits may well be the deciding factor for a prospective employee who may be choosing between your job offer and a similar one offering the same pay. A competitive health benefits package is also very likely to aid you sustain your best workers.

To procure affordable health insurance coverage for yourself
If you have or are shopping for insurance for yourself and your family, you will fetch that an individual health insurance view is likely more expensive than a group health opinion. The more employees you have, the lower the rates you can procure.

To assume advantage of available tax incentives for your business
There are a number of vital tax incentives offered to businesses that offer employees health insurance benefits. As a business owner, you can usually deduct 100% of your group health insurance premiums on qualifying plans. If your group understanding is offered as a total compensation package, you may also prick your payroll taxes.

To offer your employees tax deductions
Your employees, in their turn, will reap tax advantages by paying for their health insurance using pre-tax dollars �€” their insurance premiums are taken from their pay check before their taxes. If they bought their contain individual health insurance, they would have to pay for it with after-tax dollars. It may also potentially lower their tax bracket. Secondly, if you offer a Health Savings Understanding, not only will your employees back from lower premiums, but any earnings made on the Health Savings Memoir will also net tax free.

To increase productivity and lower absenteeism
Research has shown that people who have health insurance are far more likely to steal preventative health care measures than those without insurance. This makes them less likely to plunge ill or to let an illness or injury progress to an advanced stage before getting medical attention.
What’s more, health insurance benefits have been shown to lower the incidents of absenteeism – jubilant healthy employees are more likely to indicate up for work, and to be more productive on the job.

Conclusion
Despite its rising costs, there are many reasons why group health insurance is genuine for your business and employees. For ways to put on your Dinky Business Group Health Insurance, win a watch at this article: Top 5 Tips For Saving Money on Diminutive Business Group Health Insurance.

With the soaring costs of Health insurance, the financial toll on your little business may force you to pass on more of the costs to your employees, or to cessation offering health benefits altogether. Before you create your decision, contemplate these five well-known reasons why offering your employees Group Health Insurance may be money well-spent:

To attract and keep the best employees in a competitive job market
Survey after study has shown that after monetary compensation, employees value health insurance benefits over any other aspect of their job. Group health insurance benefits may well be the deciding factor for a prospective employee who may be choosing between your job offer and a similar one offering the same pay. A competitive health benefits package is also very likely to befriend you keep your best workers.

To pick up affordable health insurance coverage for yourself
If you have or are shopping for insurance for yourself and your family, you will accept that an individual health insurance understanding is likely more expensive than a group health concept. The more employees you have, the lower the rates you can accept.

To choose advantage of available tax incentives for your business
There are a number of distinguished tax incentives offered to businesses that offer employees health insurance benefits. As a business owner, you can usually deduct 100% of your group health insurance premiums on qualifying plans. If your group belief is offered as a total compensation package, you may also slash your payroll taxes.

To offer your employees tax deductions
Your employees, in their turn, will reap tax advantages by paying for their health insurance using pre-tax dollars �€” their insurance premiums are taken from their pay check before their taxes. If they bought their hold individual health insurance, they would have to pay for it with after-tax dollars. It may also potentially lower their tax bracket. Secondly, if you offer a Health Savings Conception, not only will your employees serve from lower premiums, but any earnings made on the Health Savings Memoir will also bag tax free.

To increase productivity and lower absenteeism
Research has shown that people who have health insurance are far more likely to pick preventative health care measures than those without insurance. This makes them less likely to plunge ill or to let an illness or injury progress to an advanced stage before getting medical attention.
What’s more, health insurance benefits have been shown to lower the incidents of absenteeism – delighted healthy employees are more likely to demonstrate up for work, and to be more productive on the job.

Conclusion
Despite its rising costs, there are many reasons why group health insurance is edifying for your business and employees. For ways to build on your Microscopic Business Group Health Insurance, steal a leer at this article: Top 5 Tips For Saving Money on Miniature Business Group Health Insurance.

Why Do You Need Health Insurance?
Where Do People Fetch Health Insurance Coverage?
What is Group Health Insurance?
What is Individual Health Insurance
What is Health Maintenance Organizations (HMOs)?
Questions to Ask About an HMO?
Preferred Provider Organizations (PPOs)?
Questions to Ask About a PPO?
Checklist: What’s Most Considerable to You?
What Is Your Best Health Insurance Prefer?  
Do you fully Understand Health Insurance Terms?  

Rates for health insurance in Georgia vary widely from one insurance company to the next. Using a agent web sites gives you the advantage of 1 cessation shopping. You accept to shop and compare health insurance rates and reimbursement with all the major plans in Georgia. This saves you time and money. 

These sites also relieve as a guide to provide you with information that will be well-known to you in your hunt for the “health insurance view that is apt for you”. 

Most companies suggest starting with the broken-down “medically underwritten” individual / family and group health insurance. On the left hand side of most sites you will accept links to information about “guaranteed lisp plans” and Plot / Federal assisted programs for outrageous income folks and special programs for family. 

You will also acquire information about pre-existing surroundings, your options when you disappear a group health insurance thought, financial rating organizations and a lot more. 

One should retract some time and behold the balance of such sites. It will be well worth your while! There is strength in numbers, especially when you are buying health insurance. As share of a group notion, you can win pleasure in a major discount on premiums as well as wide-ranging policies. 

Moreover, there is no guarantee that an insurer will recall you on. Individual plans are medically underwritten and the insurer may decline your application or affix exclusions to your policy if you have health problems. However, some states don’t allow this practice and necessitate that any insurer selling individual health plans be required to offer you a policy, no matter what medical problems you have. 

If you are faced with securing an individual insurance, do not let the bewilderment tempt you to go without. Even if you are in a healthy site at the time, you could topple off a horse or have a serious car accident and be monetarily ruined. Plus, you will lose your pre-existing-conditions coverage in most states, especially Georgia, if you go without insurance for more than 60 days. 

I know that it seems like applying for Georgia health insurance can be a lifeless process. However, it takes a lot of time and thoughtfulness to review and beget definite that you understand policy terms, area regulations and insurability. I have taken the time to assemble the following information to execute your Georgia health insurance shopping course easier. I hope that you will review the various agents’ and companies’ offerings and ask illustrative questions before you decide on the policy you fill in your heart that it best serves you and your family in a sure regard. 

Below are some companies in Georgia that you may settle from but these are unbiased examples and as I stated before do your research, finding the organization that is just for you is your top priority.

Georgia Health Insurance Plans, Individual Health Insurance Georgia, Family Health Insurance Georgia, Group Health Insurance Georgia, Student health Insurance Georgia, Affordable Health Insurance Plans, Health Insurance Quote Georgia, Health Insurance for Single Parents, Health Insurance for Children Only, Instead of COBRA, Instant Online Quote, Major Medical Health Insurance, Temporary Health Insurance, Preferred Provider organization, Health Insurance Georgia, Individual Health Insurance Georgia, Affordable Health Insurance, Georgia Health Insurance Choices.

Remove your time be patient and be very inquisitive when searching for the factual Health Insurance for You in Georgia.

When searching for a Health Thought in Georgia you should really do your research before embarking or like a flash choosing a provider. Below are some questions you should ask yourself when preparing on your mission to finding the lawful insurance conception for you. 

Why Do You Need Health Insurance?
Where Do People Win Health Insurance Coverage?
What is Group Health Insurance?
What is Individual Health Insurance
What is Health Maintenance Organizations (HMOs)?
Questions to Ask About an HMO?
Preferred Provider Organizations (PPOs)?
Questions to Ask About a PPO?
Checklist: What’s Most Vital to You?
What Is Your Best Health Insurance Prefer?  
Do you fully Understand Health Insurance Terms?  

Rates for health insurance in Georgia vary widely from one insurance company to the next. Using a agent web sites gives you the advantage of 1 terminate shopping. You pick up to shop and compare health insurance rates and reimbursement with all the major plans in Georgia. This saves you time and money. 

These sites also assist as a guide to provide you with information that will be significant to you in your hunt for the “health insurance conception that is correct for you”. 

Most companies suggest starting with the outmoded “medically underwritten” individual / family and group health insurance. On the left hand side of most sites you will secure links to information about “guaranteed enlighten plans” and Space / Federal assisted programs for grievous income folks and special programs for family. 

You will also score information about pre-existing surroundings, your options when you travel a group health insurance belief, financial rating organizations and a lot more. 

One should win some time and watch the balance of such sites. It will be well worth your while! There is strength in numbers, especially when you are buying health insurance. As portion of a group conception, you can win pleasure in a major discount on premiums as well as wide-ranging policies. 

Moreover, there is no guarantee that an insurer will prefer you on. Individual plans are medically underwritten and the insurer may decline your application or affix exclusions to your policy if you have health problems. However, some states don’t allow this practice and necessitate that any insurer selling individual health plans be required to offer you a policy, no matter what medical problems you have. 

If you are faced with securing an individual insurance, do not let the bewilderment tempt you to go without. Even if you are in a healthy location at the time, you could drop off a horse or have a serious car accident and be monetarily ruined. Plus, you will lose your pre-existing-conditions coverage in most states, especially Georgia, if you go without insurance for more than 60 days. 

I know that it seems like applying for Georgia health insurance can be a expressionless process. However, it takes a lot of time and thoughtfulness to review and accomplish distinct that you understand policy terms, status regulations and insurability. I have taken the time to assemble the following information to beget your Georgia health insurance shopping course easier. I hope that you will review the various agents’ and companies’ offerings and ask illustrative questions before you choose on the policy you hold in your heart that it best serves you and your family in a obvious regard. 

Below are some companies in Georgia that you may decide from but these are honest examples and as I stated before do your research, finding the organization that is accurate for you is your top priority.

Georgia Health Insurance Plans, Individual Health Insurance Georgia, Family Health Insurance Georgia, Group Health Insurance Georgia, Student health Insurance Georgia, Affordable Health Insurance Plans, Health Insurance Quote Georgia, Health Insurance for Single Parents, Health Insurance for Children Only, Instead of COBRA, Instant Online Quote, Major Medical Health Insurance, Temporary Health Insurance, Preferred Provider organization, Health Insurance Georgia, Individual Health Insurance Georgia, Affordable Health Insurance, Georgia Health Insurance Choices.

Seize your time be patient and be very inquisitive when searching for the apt Health Insurance for You in Georgia.

When soil containing these fungal spores is terrified they become airborne and can be inhaled by humans and animals. This disturbance can be caused by anything from humans digging and animals playing in the soil to dust storms and earthquakes. Immunocompromised patients, young children, the elderly and members of several ethnic minorities have a higher risk of contracting Valley Fever (4). Although these groups have a higher level of risk, coccidioidomycosis has been known to affect a wide range of individuals from prison inmates and archaeologists, to drug sniffing dogs along the Mexican border. In unusual years, cases in prisoners at a California Central Valley correctional have reached as high as 1 inmate in every 10 tested (4).

The significant things to understand when learning about this disease are its cause, what is being done to prevent and cure it, its prevalence, and risk factors. This paper has been assembled to address these issues regarding Valley Fever. This paper focuses on four main stakeholders in this Valley Fever epidemic, the medical industry, infected individuals and insurance companies, infected animals and construction companies.

Medical Industry

Valley Fever is a respiratory disease caused by airborne fungi spores from Coccidioides immitis that enter and grow inside the lungs and cause infections. About 60% of the people do not realize that they have this disease because it can cause no recognizable symptoms and can only be positively identified by a skin test. The 40% of the remaining population can fetch peaceful to severe symptoms. The disease can manifest in three different types of forms; acute, chronic, or disseminated. Each execute ranges from minor to severe consequences. Most considerable of all, is to know what the symptoms of Valley Fever are. There are ways to narrate if someone might be infected and those symptoms include chest pain-which is a constriction that makes it difficult to breath, fever, muscle stiffness, joint stiffness, wheezing, cough, loss of appetite, chills, and change in mental location. Those symptoms appear any where from 10-30 days after exposure to the spores. After one or two weeks some people will originate to invent painful rashes and or lumps on the lower plot of the legs. Symptoms that can be linked with the disease once contacted include joint swelling, joint injure, arthritis, ankle, feet, leg swelling. All of theses symptoms may not accrue in everyone and can vary from detached in some people to severe in others. Showing more then one of these symptoms should be a gracious indicator that the person has contracted the disease and should consult a doctor.

Once a body is infected, Valley Fever will expose up in one of three forms acute, chronic, or disseminated. Some of the forms are more rare then others. Depending on the make that Valley Fever takes, the severity of the effects on the body and how unsafe it can be will vary. The acute obtain is rare and about 3% of the people that live in places with coccidiomycosis found in the dirt, will expose the development of the disease. This can happen at any time during the year or any season. It affects both men and women equally and the systems will depart like the body has caught the flu. Chronic manufacture is rarer and less approved then the acute obtain. It is more hazardous than the acute effect and can cause more problems. The chronic accomplish can become evident and invent after 20 or more years from when the person first got the infection. This may not have been found, treated, or even discovered by the person with the disease.

Valley Fever can cause infections in the body and compose lung abscesses. These abscesses can pop and erupt, releasing pus into the lungs. This pus then travels to the pleural area or the plot between the lungs and the ribs. This can cause serious injure to the lungs and the person will have a difficult time breathing. Other symptoms include improper grade fever, weight loss, and nodules in the lungs. The disseminated originate is the most uncertain and severe out of the three. This is when the disease spreads to the different parts of the body. The infection gets into the person’s bones, lungs, liver, meninges, brain, skin, heart, and around the heart. It is found that 30% to 50% of those people infected with this construct also find meningitis. This beget can be very deadly as it can cause swelling around the brain and spinal cord. With this acquire, healthcare providers often discover ulcers and skin lesions, painful lesions in the skull and spine or bones, and painful, swollen joints. This is a life threatening invent and can cause death if not treated correctly. It can cause brain distress as well and can affect the brain/mental spot of the person.

Everyone in the world is different and so not every person is going to be infected the same plan. People of different color or urge can contract the disease more readily then others of another hurry can. The people of Asian, Hispanic and African descent are more susceptible to the diseases than Caucasians. Even though it is really unclear why, those of color are 10-20 times more likely to find the disease. Most cases that ended up in the emergency rooms were of Hispanic or African origin. Other people that have a high infection rate are people that are diabetics or weakened immune systems such as those with AIDS. Also women that are pregnant, in their third trimester or moral after their babies are born, are at an increased risk of getting Valley Fever. All of these factors will acquire it easy for them to win the disease because their bodies can’t resist the initial infection. As well as with the lower immunity’s the body can’t fight succor as well causing them to secure worse quicker and will be more severe. Age is a titanic factor as well seeing as older adults have a higher chance of developing Valley Fever then an younger age. This is because their immune systems are less active or have other medical conditions that lower their ability to fight off the infection. Individuals with extinct immune systems are at higher risk for complications which may lead to the disseminated do. It lets the disease spread easier through out the body and lets it find into the critical systems of the body. This can obtain the body more susceptible to other types of infections because of the further weakening in the immunity from Valley Fever.

Valley Fever, as stated, gets stirred up into the air from fresh construction or gardening, allowing one to breathe it in. Once it gets into the lungs it sticks in the inner section of the lungs. There it will grow and multiply inside the lungs. Depending on what perform it takes it can obvious up from there or release pus. This pus then can accumulate absorbed into the body and stick to different types of organs. It can especially target places where it can gain up in such as joints, feet, and legs. This is because the fungi pick up into the blood stream which will accept absorbed by muscles, bones, and under the skin where it can deposit and grow. If the immune system is not strong enough, it can not waste the infection which allows it to further mitigate as it builds in different spots of the body. Since it goes into the body’s blood stream it can accept to where ever the blood is flowing. This includes vessels around brain and the spine. This will cause different reactions such as the person affected might lose some perception and awareness because of the lack of desirable blood being given to the brain. With the fungi being deposited in places such as the feet or skin it causes swelling because it will effect liquid or more pus-like substance. This will cause the joints to swell up because of excess liquid causing arthritis. Besides looking at the symptoms of the person there are many other ways to resolve if there is a Valley Fever infection. Different medical professions utilize different ways to choose the infection in the body and depending on the degree of the disease.

A chest x-ray can be taken to figure out if one is infected. In the x-ray the doctor would be looking for light areas in the lungs that are poorly defined or patch areas. The space where disease is growing will reveal up usually arrive or next to the ribs as most of it grows and deposits there. A skin test can be given as well and it is called the spheriulin skin test. This test looks to watch if the person is infected with the fungus and since it is more sensitive it can capture up signs of an earlier infection accurately. Spheriulin is an antigen that is connected with the fungi that causes Valley Fever. This substance is injected impartial a limited below the skin, preferably in the forearm similar to a TB (PPD) test. Then the doctor will sight at the arm or the position it was injected at 24 and 48 hours after the test. If the body has antibodies to the fungus, and it is in their system, the body with react and the location will become red and swollen. Although this test is not being old-fashioned as grand anymore because it is not as specific, it however is faded in researching to understand the disease. A more well-liked test is a sputum culture. This is where the doctor or nurse retrieves sputum from the patient. Sputum is the mucus-like secretion in the bronchi tubes or where the air goes to the lungs, and comes up with deep coughing. The doctor or nurse will ask the patient to cough deeply and spit up any sputum into a sterile cup. This will be taken to a lab that allows it to grow to contemplate if Valley Fever is show. The doctor my tap on the chest or have the person inhale steam-like mist to benefit cough up the sputum in order to accept a better sample. One of the last tests that may be done is a coccidiodes antibody test. This test is where the blood is taken to analyze if there are any antibodies to the fungus in the body. If the antibodies are indicate it can mean that there is an ongoing infection or a prior one. The test and blood may be taken a couple of weeks after to contemplate if there is a rise in the antibody count which determines the infection and how severe it may be. The higher the titer or antibody counts the worse the infection it is. These are all tests that the doctors may expend in determining more accurately if the disease is note in the body. This is the only diagram to be 100% certain that there is an infection.

Depending on the magnitude of the infection different treatment options will be provided by the doctors. Some of the forms may even dissipate with no medical interactions as well. The acute disease will usually go away without medical intervention. Approved management is bed rest and treatment for flu symptoms until the fever goes away. With any of the other forms, medication would be needed to win care of the disease. If the quandary persists or if there is a higher possibility of complications and it is in its more severe obtain, antifungal medications would be required to be taken. These medications would include amphotericin B, ketoconazole, fluconazole, or itraconazole. In a chronic obtain or more acute obtain that won’t go away, amphotericin B is usually the medication given to wait on fight off the disease. Then the person is monitored as to compose distinct the condition does not worsen which might last from a couple months to a year. Surgical action may be an option to hold care of lesions that are localized. For the disseminated execute fluconazole or itraconzole is commonly old-fashioned. The dosage is usually 400mg per day and in some cases 2000 mg of fluconazole or 800mg of itraconzole per day may have to be taken in 200mg doses. Amphoterican B may be ragged as an alternate in this position if lesions are getting worse more fast and is extinct to diffuse pneumonia. Surgery is critical in this case and in most reports at this stage it is primary. This is aged to prefer care of tremendous abscesses, destructive lesions or bony sequestrations instability of the spine or the movement on important organs such as the heart or tissues such as the spine. Since this build is the worst and in most of the time fatal more actions are required in recovery as compared to the more acute forms. Treatment of the disease does not execute it go away for wonderful as relapses can occur or the person can acquire it again.

The disease can have short affects and long term effects on the body. Depending on the person or the amount of spores inhaled, this will settle the longevity and affects of the person. The short affects include flu like symptoms and will go away. It is an annoyance unbiased like any time someone gets sick and the person can go on with their life with no pain. These people probably have higher immune systems. However, the longer the disease stays around in the body the more damage it will do. If it is prolonged in the body for an extended time it will commence having more harsh affects on the body. The infection can spread to the bones in the body and cause deterioration or holes in the bones. This will quit with the patient through out their life. If it is in the body for the extended time it can cause variations of getting better then getting worse fluctuations as well as can cause relapses of the disease where it can arrive encourage. If not treated, the non-acute earn will worsen over time and in most cases secure into other organs of the body and produce the disseminated type. Taking care of the infection early on would be a friendly strategy as Valley Fever can cause death if not treated at the legal time. If the disease is prolonged it can cause other diseases or illnesses. These include forming pneumonia and meningitis which perform the condition that considerable more deadly and difficult to treat. As both of those diseases are fatal as well and can manufacture abominable mixes with Valley Fever. Bleeding and lung abscesses could originate which have to be medically treated and in some cases have to be done with surgery. Prolonged exposure can attach the person at improper discomfort as the pus gets into the lungs and fills the lungs making them feel like they’re drowning and can’t breathe. This can cause many abominable effects as the body can’t gain enough oxygen into the body. People that already have respiratory problems such as asthma can be compromised and hinder the lungs from working efficiently. This can cause a more acute create such as short of breath to something more hazardous as not getting any air in and halt breathing without medication or immediate treatment. Most importantly the disease should not be taken as lightly as it can cause death if overly prolonged or gets into its most risky forms in the body. Many problems and complications would have to happen in order for it to derive to that severe of stage. As long as the disease is recognized and treated (if need be) then the affected person can easily recover.

Many people who have Valley Fever don’t even know they have had it because the severity changes in everyone and 40% of the people would expose symptoms and require little to major treatment. This disease changes over longer periods of time. A person may have some time to go spy a doctor before they feel the severity of the disease. Though, as stated earlier, waiting for long periods of time to peer medical care would not be marvelous to one’s health. This disease is taken in most of the medical field taken very lightly even though misdiagnosis and prolonged exposure to the disease can be fatal to the person’s health. It can have affects on the body that cease with them for years at a time or even there entire life. This is something that if in seek information from consulting a doctor would be the best course of action so treatment can originate so complications don’t arise.

Infected Individuals & Insurance Companies

There are many considerable stakeholders that would be affected, at least in some capacity, if an executive decision were to be made with regards to the pronounce of Valley Fever. Arguably, the role of infected persons or those that contain a unusual vulnerability to the disease is top priority on the decision-maker’s list. Each year, thousands of people are diagnosed with Coccidioidomycosis in Arizona alone. In a 2007 article, the Washington Post wrote that Valley Fever cases diagnosed in 2006 were up fifty-six percent from a year earlier. This prompted Arizona health officials to sign the disease at, “epidemic proportions,” as thousands of other cases likely went undocumented. It has also been reported that anyone who has spent enough time in Arizona, or any other portion of the Southwestern United States where soils acquire the Valley Fever fungus, will contract the disease at some point. Only a dinky percentage of people, however, are diagnosed with a severe enough originate of the infection where medical treatment is needed. Anti-fungal medication is the most well-liked treatment for Valley Fever. But, there are rare cases where surgery is required to fully recover from the disease. Overall, tens of thousands of cases are reported around the United States annually and the number of Valley Fever-related deaths is estimated at 50-100 each year. It is primary to glance individuals currently struggling with the disease as well as those who have recovered from a serious do of Coccidioidomycosis as a stakeholder with regards to this screech because there exist many factors that affect the lifestyles of those individuals, their families and their friends. In an exertion to better attend this claim, the lives of two patients that contracted a serious execute of the infection, will be addressed and analyzed in the following paragraphs.

Before introducing specific cases, it is considerable to review some fresh facts and figures with regards to the disease. The Arizona Department of Health Services released their annual Valley Fever Portray in October 2008. The narrate, co-compiled by the Office of Infectious Disease Services and the Bureau of Epidemiology and Disease Control, presents the amount of Coccidioidomycosis cases reported in 2007 through a myriad of graphs. These graphs sing the research information in a thorough and comprehensive procedure to the reader by dividing up Valley Fever statistics for the 2007 year in a multitude of categories. Some of these categories include: cases reported in ‘07 according to specific age groups compared years past and a five-year average, separating the number of Valley Fever cases reported by counties in Arizona, and separating the number of Valley Fever cases reported in both mining and non-mining areas within the position. Although many people judge of this disease as a peaceful illness similar to the approved wintry, Valley Fever is a key tell amongst Arizona residents as well as both local and national governments. In 2008, the Arizona Department of Health Services received funds for Valley Fever prevention and control from a legislative appropriations committee. The Center for Disease Control and Prevention (CDC) also awarded the department funds for continued research. As fragment of the 2007 portray, Health Services interviewed roughly ten percent of all Arizonans diagnosed with Coccidioidomycosis during that year. According to the ADHS, the following are some of the most alarming facts that were discovered from the interviews:

• People missed an average of 1 month of work, for a total of 4,918 days

• People with Valley Fever could not construct daily activities for an average of 3 months or a total of 92 years

• People with the disease waited an average of 44 days before seeking healthcare

• Patients saw their doctors three times before they were tested for Valley Fever

• There were $86 million dollars in hospital charges for Valley Fever in 2007

Furthermore, Arizona has the highest number of reported Valley Fever cases annually in the United States, accounting for sixty percent nationwide. In total, more than 150,000 people across the country are estimated to contract some obtain of Coccidioidomycosis each year. The Arizona Department of Health Services reports that the severity of Valley Fever in the area continues to grow as do the overall number of persons infected each year. Due to the fact that currently there is no cure or vaccine for the disease, every person that is susceptible to the effects of Valley Fever certainly shares some kind of stake in the debates of the roar. Examining the personal accounts of two anonymous patients afflicted with a serious execute of Coccidioidomycosis can bring further clarity to this claim. Any and all personal information for the following accounts has either been fictionalized, changed or generalized to beget complete anonymity.

The first case will put a question to the nefarious effects of Coccidioidomycosis on a male patient of early adulthood age. This individual will be referred to as Patient “V” throughout this paragraph. Patient “V” began his ordeal with Valley Fever in the summer months of 2001. A younger man in the final years of adolescence, Patient “V” experienced generic, flu-like symptoms, which he disregarded as nothing principal like most other sufferers settle to do. “At first, I noticed that my lymph nodes in my neck were unusually swollen…I figured it was unbiased a cool or some cramped infection or something like that.” Soon after the initial stages of the disease, Patient “V” began experiencing constant, severe injure in the left side of his chest. Although he made numerous medical appointments for this spot, the injure would subside by the time Patient “V” arrived, making it difficult to diagnose the pickle. “What was happening was my left lung had a hole in it and it kept collapsing and then re-inflating by the time I got to the doctor’s office.” Eventually, a chest x-ray was performed on Patient “V” and this revealed a petite, shaded position on his left lung. The set indicated a relatively petite, but necessary hole through the lung. The dilemma required corrective surgery and Patient “V” was admitted to one of Arizona’s hospitals in August, 2001. Surgeons sewed up the hole in Patient “V’s” left lung and released him after a day of recovery. Within weeks following the surgery, Patient “V” experienced a relapse of his earlier symptoms. “…I was playing Volleyball one night and in an instant, there was this intense damage in my chest…I felt dizzy and could hardly breathe.” Patient “V” immediately returned to the hospital sometime in November of that year where further tests concluded that the infected share of his left lung was, indeed, Coccidioidomycosis. Another surgery to completely select this share of infected lung was performed successfully and Patient “V” spent more time recovering in the hospital. “The effects from the disease itself were painful enough, but the worst harm came from the chest tubes that were inserted into me in the hospital…At one point, they shoved one of the tubes through my ribcage and into my lung and I wasn’t even on distress medication.” Fortunately for Patient “V”, the second surgery was successful and he survived his brush with Valley Fever. In many cases, patients who contract and fend off the infectious spore fabricate up life-long immunities. However, reports have also shown that patients in remission from Coccidioidomycosis can be more vulnerable to a reoccurrence of the disease than those that have never contracted it. Following his surgical recovery, Patient “V” was prescribed an anti-fungal medication called Diflucan, a favorite drug distributed to sufferers of the infection. Patient “V” was required to prefer this medication daily for 2-3 years. He now receives chest x-rays once a year to check for any returning signs of the fungus. Patient “V’s” scar tissue has also become virtually unrecognizable after nearly a decade of recovery.

The second case to be analyzed will be that of a middle-aged female patient. Appropriately, this patient will be referred to as Patient “F” throughout the analysis. Patient “F” contracted Valley Fever in behind 1995. Early symptoms experienced in this patient included chronic loss of breath and improper joint discomfort. The obtain of Coccidioidomycosis contracted by Patient “F” was not diagnosed correctly until 2 ½ years after symptoms began. Before visiting a pulmonologist, Patient “F” was given a chest x-ray, where a grand, round nodule was located somewhere on her left lung. The patient was admitted to the hospital in 1998 and underwent a wedge resection, to select the infected section (removed in wedge produce) of the lung. After the first surgery, Patient “F” was prescribed anti-fungal medication similar to Diflucan at plump strength for six beefy months; and then half the dosage for another six months. The patient continued to have fevers following the surgery. She also had an excess amount of fluid in her lung. Patient “F” returned for a second surgery to further spruce the infected site and completed another sequence of antibiotics afterwards. The time spent in the hospital for recovery totaled at six days for each surgery. Patient “F” was fortunate enough to have flexible employment benefits to fully recover. “My company provided short-term disability; up to 6 months with 100% pay…I was very lucky.” As far as medical coverage is concerned, Patient “F” had slight out-of-pocket costs through United American. However, she was mild scared to peep the total amount owed from her cease in the hospital. “The bill after six days in the hospital, which included one day in ICU and five days on a regular floor, was extraordinary. Impartial for room and board and a diminutive medication, the bill was $28,000.00.” Today, Patient “F” has fully recovered from the infection and only has one suggestion with regards to the snarl of Valley Fever. “Educate physicians on the east hover and west cruise, all over the Untied States to properly test for Valley Fever.”

Needless to say, there are always financial burdens associated with any type of surgery as well as prescription medication. In the case of Patient “V”, a total of nearly $180,000.00 was accrued in hospital bills after the two surgeries were performed. Additionally, the drug Diflucan can range from 36 dollars to 60 dollars for 100mg/10 pills depending on the plot of buy. It is necessary to gaze medical insurance companies as a stakeholder with regards to the assure of Valley Fever as well. Because there is no cure or vaccination for the infection, insurance companies limit the amount of coverage to persons with preexisting conditions. If a cure were to be developed and released into the market, insurance companies would most likely include Valley Fever coverage into any conception. Unfortunately, without medical insurance, the overall amount of money needed to recover from a serious infection like Valley Fever is simply insurmountable for the majority of Americans. Even with sufficient medical insurance, however, people who have had Valley Fever in the past are typically not covered for a relapse of the infection. Patient “V” currently receives individual health insurance under a PPO from Blue Inappropriate Blue Shield of Arizona. As mentioned earlier, however, major insurance companies like this one tend to limit coverage to individuals with preexisting conditions. According to an article on www.howstuffworks.com, a preexisting condition is a health condition or illness that you have had before your first day of coverage on a modern conception with an insurance company. Typically under group coverage, such as that offered by a corporation under an employee’s benefits, a person with a preexisting condition can come by stout coverage, but will have to wait anywhere from nine months to a year before it kicks in. This period is enforced by insurance companies to insure that a patient is not constantly having relapses of the same condition. However, a person with a preexisting condition will rarely receive private health coverage that includes their condition. This is referred to as the preexisting conditions exclusion. Our attempts to contact major medical insurance companies or medical insurance agents for further clarity on this swear went unanswered. Unfortunately, people like Patient “V” who have preexisting conditions, are self-employed and do not qualify for group medical insurance will have to pay out-of-pocket if their conditions return. “I would have to jabber bankruptcy if that happened…” Patient “V” explained. “I live in panic because I know that if I were to regain it again, that would be disastrous.”

Currently, a vaccination for Coccidioidomycosis is under development at the BIO5 Institute on the campus of the University of Arizona. Leading the development is Dr. John Galgiani, Director of the Valley Fever Center for Excellence and Chief Medical Officer for Valley Fever Solutions, Inc. This vaccination will be intended for both humans and dogs, which can also contract deadly forms of Valley Fever (this topic will be further discussed in later sections of this recognize). In March, 2008, Dr. Galgiani teamed up with fellow BIO5 colleague Dr. David Nix of the Department of Pharmacy Practice and Science to research the vaccination. “We had some complimentary expertise and mine’s mainly in the spot of drug development and drug development science and so on. And Dr. Galgiani is kind of the world’s expert on Valley Fever,” Dr. Nix reported in a 2008 Valley Fever instructional video produced by the University of Arizona. The two physicians, under the company name Valley Fever Solutions Inc., are financially backed by the University, private donors and C-Path, a Fresh York based foundation. They are currently testing an anti-fungal called Nikkomycin Z, which was first mature to prevent fungal degradation in do. With approval from the U.S. Food and Drug Administration, Nikkomycin Z is in Phase 1 of drug safety trials. According to a news release published on the BIO5 Institute’s website, “The company has already obtained a Science and Translational Technology Research (STTR) grant from the National Institutes for Health that will assist fund pharmacology studies that will benefit perform future clinical trials. The first phase of that grant is worth more than $100,000, with the potential for an additional $700,000.” If this vaccination proves to be a viable cure for Coccidioidomycosis, many aspects of the snarl of Valley Fever would certainly change. Once a cure hits the market, the number of deaths and serious cases as a result of Valley Fever would plunge significantly. Debates between the government, politicians and special interest groups would decrease as well if no one were in any actual threat of the infection anymore. Briefly returning to the topic of medical insurance, people with Valley Fever as a preexisting condition will be able to feel more score because of the availability to a cure, and possibly insurance that covers that cure. Major medical insurance companies like Aetna, Blue Harmful Blue Shield, Cigna and Humana will more freely distribute fleshy coverage in instances of Valley Fever. Like most vaccinations and cures to approved infections or diseases, there would be many determined outcomes to releasing this drug into the medical market, pending the completion of all drug safety trials.

As essential stakeholders with regards to the notify of Valley Fever, both infected persons and medical insurance companies would be greatly affected if an executive decision were to be made, or possibly a vaccination released into the market. While the future looks suited with regards to a feasible solution to the Coccidioidomycosis fungus, it is imperative that all people procure a contrivance to collect health insurance coverage to some capacity. It is also distinguished that individuals with preexisting conditions that aren’t on group medical plans lobby for their rights to complete insurance coverage. In considering the outrageous effects of Valley Fever, there are many people who mediate this topic is objective as famous to the animal world as well.

Infected Animals

Valley Fever does not only affect people but it is now more commonly being found in animals. Animals are unprejudiced as likely to fetch Valley Fever as humans are. Animals rep Valley Fever in the same arrangement as humans do, by breathing the fungus. It has been found that more and more animals are being reported of becoming ill due to this fungus. It has been found the 30-40% of animals who breathe in the fungus accumulate sick. Some of the most favorite animals to be reported with Valley Fever are dogs, cats, llamas, non human primates, horses, and zoo animals (3).

A golden retriever went into the vet’s office; the dog wasn’t feeling well and wasn’t acting himself. The vet takes an x-ray of the dog’s lungs and sees white spots in the lung site where there should normally be unlit patterns. The white spots demonstrate that the dog might have cancer in its lungs. The dog is only four years ragged, which is when a dog should be at its prime and not getting lung cancer. Lung cancer isn’t usually found at this young of an age and doesn’t seem to obtain as lickety-split as it has in this golden retriever. The owner had said unprejudiced two weeks prior to going to the vet that the dog was chunky of energy on their vacation. The veterinarian doesn’t all the facts add up for the dog to have cancer so she decided to accelerate a few more test before she starting treatment for lung cancer. The dog’s health over the course of time starts to go downhill and very quickly. The dog starts to cough, has a loss of appetite, and shrimp to no energy. The vet then found out where the human family had recently traveled and they were in the Southwest. After hearing this, the vet definite that it must be a fungal disease and it was fair that, it was Valley Fever (1).

Dogs are the largest infected and most commonly reported animals with Valley Fever. Dogs catch Valley Fever in the same diagram that humans do and in the same regions as humans do. The fungus is spread through spores which dogs can easily inhale. Once the fungus is inhaled, the spores grow into spherules which enlarge and eventually burst into hundreds of endospores (3). This causes the spreading of the infection into the lungs. A dog’s immune system should answer and surround the infection to slay it. Dogs that do not become sick due to the fungus are considered to be asymptomatic (2). When a dog does become sick from Valley Fever, their immune system fails to extinguish off the infection and the infection continues to spread into the lungs and then can depart throughout the dog’s body (3).

Once a dog is infected with Valley Fever, there are definite symptoms that become indicate. Some of the symptoms that are seen in dogs are weight loss, coughing, fever, lack of appetite, and lack of energy (3). The cough in dogs can be seen as early as the first week of getting the infection to as tedious as 3 weeks. The cough that dogs acquire is due to the development of pneumonia which is visible on x-rays. The coughing can be caused due to pressure on the lymph node advance the heart and puts pressure on the dogs windpipe which as a result irritates it (3). After the cough is point to the loss of appetite and energy is soon to follow. If the infection is not controlled it can become powerful worse and spread throughout the body. When the fungus is spread throughout the body it causes systemic or disseminated disease (3). When this happens the symptoms and condition of the dog becomes remarkable worse. The symptoms that become indicate are: swelling of the limbs, attend and neck injure, seizures, soft swelling under the skin that resembles abscesses, swollen lymph nodes, study inflammation, and non-healing skin ulcerations (3). Not all symptoms are show good away and it can capture several months before determined symptoms appear. It can be several months after a cough appears that other symptoms become reveal. There is typically an order that the fungus spreads throughout the dog’s body. The first organ to be effected is lung, and then the infection usually spreads into the bone, than eyes, heart, testicles, brain, spinal cord, and finally abdominal organs (2).

To decide if a dog has Valley Fever there are different test that can be done. Some of the most accepted test done to decide if a dog has been infected is blood tests, chest x-rays, bone and joint x-rays, and Valley Fever blood test (3). Test results may expose up negative up to 3-4 weeks of receiving the infection so in some cases test need to be repeated to confirm that the dog does or does not have Valley Fever (2).

There are different treatments that be done to back fight the fungus. The process of treating Valley Fever may be long; medication can be given for up to one year (2). The length of time that the treatment will win usually depends on how far the fungus has spread throughout the body. Most commonly oral antifungal medication is given to the dog. These antifungal medications are ketoconazole, itraconazole, and fluconazole (2). Ketoconazole is the most commonly prescribed medication due to the fact that is it the least expensive. This drug is usually given twice daily and with food. Itraconazole is a more expensive medication but has fewer side effects than ketoconazole. Itraconazole is also better for dogs that are having problems keeping their food down because it has a faster absorption rate (3). The third medicine most commonly given out for treatment is Fluconazole and it is also expensive with minute side effects. This is usually given to dogs that have afflict done to their spinal cord and nervous system (3).

Cats, llamas, non human primates, horses, and zoo animals are other animals that have been reported with Valley Fever. Cats that have Valley Fever reveal the same symptoms as dogs do but it less likely for a cat to procure Valley Fever than it is for a dog. Cats accept Valley Fever about every 1 case compared to 50 cases in dogs (3). When cats obtain the fungus their symptoms are usually a microscopic more advanced than dogs. Two of the major symptoms seen in cats that have Valley Fever are unexplained weight loss and skin ulcerations that won’t go contrivance. The same treatment for dogs can be ancient to treat cats with Valley Fever (3).

Horses are another animal that have been found to gain Valley Fever. There have not been very many cases reported but in the ones that have only one horse has survived Valley Fever with treatment. All the other horses that were reported with Valley Fever had to be euthanized. The reports of these cases are not very unique though, and with medical technology improvement chance of survival with unique medicine is remarkable better for horses today (3). Llamas are another animal that have been infected with Valley Fever. Llamas are very sensitive to this fungus. In most cases, if a llama has Valley Fever death is almost always the outcome.

Zoo’s that are located in the Southwest are very aware of Valley Fever. Many zoos have lost animals due to Valley Fever before they were aware of what is was and how to treat for it. When animals become sick, Valley Fever is something that is tested early so treatment can be started. In zoos, the most well-liked animals to accept Valley Fever are: Monkeys, Apes, and other primates. These animals expend the same treatment process as dogs and cats but is usually consists of a lifetime treatment (3).

Valley Fever is a very serious stutter that is rising in animals. Currently there are no preventatives for Valley Fever. The treatments for Valley Fever for animals has become better and better over time. The reach in technology has allowed for veterinarians to be able to detect Valley Fever at a less near stage. The early stage that Valley Fever is caught at allows for a better chance of survival of animals infected with the fungus.

Construction

There is no doubt that construction companies contribute significantly to Valley Fever. According to the MayoClinic, institution known for prominence in the medical field recognized the increase in precise estate has contributed to the spew of “thousands of tons” of dust carrying this fungus into the air. The article looks at how in the 1990s the accounts of Valley Fever increase in the states of Arizona and California due to some important factors. Among those factors like dry climate, the unique building booms have been one of the most distinguished factors that have contributed to such increases. The mercurial clearing and building were a important source for the increase in reported cases of Valley Fever. Among all the contributing factors of Valley Fever, environmental exposure ranks high, if not the necessary cause. Experts also added that almost half of the people who live in areas where Valley Fever is prevalent have contracted the disease. Interestingly, people who are at most risk are those who are exposed to directly to dust like those who design jobs in the field of construction, ranching and agricultural work (1).

The decade following the 90’s has had a mountainous increase in reported cases of Valley Fever. Those areas that have reported such increases are the states of California and Arizona. These states have been induced with a massive building pronounce. The mass migration to these “sun belt” states made for a widespread land clearing and construction, which ultimately directly contributed the spread of the air borne fungus (2). Importantly, some measures are currently in area to purposely gash the amount of dust construction companies contribute to the environment.

The Environmental Protection Agency (EPA) is an agency of the federal government of the United States who is in charge of protecting human health by maintaining the natural environment trustworthy (3). This implies its commitment and dedication to monitoring and posing regulations for anything threatening the quality of the air. The EPA has residence limits on how powerful pollution is allowed to be in the air. In its goal to acquire and manage the air we breathe, EPA has passed several pieces of legislation that have reduced the amount of smog and pollutants in the air. Among valuable legislation is the Well-organized Air Act which has been passed to enforce smart air standards and improve human health. The Elegant Air Act is an outline for what national, region, and local authorities must follow in order to protect air quality. Under the Desirable Air Act, local and position authorities are responsible for abiding by the national ambient air quality standards. The Environmental Protection Agency states Maricopa Country cannot exceed the federal health standard for particulate pollution more than three times in a three year period (4).

According to the Environmental Protection Agency (EPA), Maricopa County has been in violation of particulate pollution since 1996. Particularly 2008, there have been nine different days where at least one of the monitors exceeded the federal health standard for particulate pollution. The health standard for particulate pollution is that it cannot exceed more than 150 micrograms per cubic meter measured over a 24 hour period of time. It’s critical to know Maricopa County has 24 air monitoring sites in the Valley. The spot of Arizona, under the Arizona department of environmental quality has its absorb air monitoring sites as well. If any of these monitors exceeds the federal health standard for a given pollutant, the EPA will beget Maricopa County accountable. According to the Environmental Protection Agency (EPA), Maricopa County failed to approach attainment for particulate pollution and thus is under federal orders to slash particulate matter pollution. In an attempt to address the swear, Maricopa County, the Maricopa Association of Governments (MAG) and local cities and towns submitted a understanding to the EPA to prove how the county plans to cleave PM₁₀ emissions by five percent each year until noble levels are reached. The Five Percent Notion outlined more than 50 commitments to cleave dust. Of these commitments, some affect the procedures and guidelines on construction entities (4).

Speaking with Erin Dunsey of Maricopa County Air Quality Department, the county is currently working hard to pose regulations on construction companies in order to lower dust emissions and ultimately lowering the potential threats from Valley Fever. The principle responsibility for The Maricopa County Air Quality Department’s Dust Compliance Division is to protect the public from the dangers that advance from airborne particulate matter (7). This division of dust compliance deals with fugitive dust sources and the rules to minimize the production of it. This means that fugitive dust from any source, including constructions areas, must be restricted in their construction operations to own within profitable dust standards. As fraction of the compliance, Maricopa County has devised that all sites with shy surface areas of dust must comply with “Rule 310″ (5).

Under Rule 310, the Dust Compliance Division has established limitations and requirements for the implementation of process controls as well as other guidelines that will encourage enforce respectable fugitive dust control measures. One of the first major steps for construction companies to follow is the obtainment of a permit. The Air Quality Department requires a construction permit for companies who opinion to conduct activities any that will disturb a surface set equal to or greater than 0.1 acre. Complying with the construction permit requirements is often a important and daunting task. Before applying for a permit, a conception that outlines the measures that will prevent the creation of dust must be presented. This conception also describes all the measures that will be implemented at anytime during the phase of construction. Therefore, this guideline requires dust generating sources to meet standards and at the same time apply best the available control measures in order to attempt to minimize fugitive dust emissions. This device being the first of many that have been imposed on construction companies, entitles that all workers or subcontractors on dwelling understand their responsibility while on situation (6).

Another hassle that companies have to deal with is the logging of control measures. Once again, under Maricopa County’s Rule 310, construction companies who conduct a dust generating operations that require a Dust Control Notion must retain a written log recording the true application and execution of the control measures previously outlined and celebrated by the Dust Control Understanding. This is a daily detailed recordkeeping which records what actions are being conducted in dust-generating operations in what may include daily inspections for crusted or damp soil. Another share of describe keeping is the trackout conditions. This rule also requires that all work sites that are more than two acres and acquire terrorized surfaces must install a trackout control devise. These devises are mountainous contributors to the retention of fugitive dust. Trackout is simply the particulate matter from tires and other sources that have fallen onto paved areas that are accessible to the public. The rule states that trackout must be little to 25 cumulative linear feet (6).

Rule310 is an extensive and overwhelming region of requirements established to lower dust emissions. Allotment 309 list another requirement under Rule310 that companies must abide by. The rule says that if the residence of interest is more than one acre a series of dust control training must steal situation. All workers directly interested in the containment of dust like the water truck drivers and water pull drivers must select a basic dust control training class in which attendees will ultimately become certified if successfully completed the training class. An extension from this portion lists that a dust control coordinator must be indicate on job spot if the dimension of the job residence is five acres and up (5). These onsite coordinators must have completed a comprehensive dust control training in which they are given expedient training on regulating emission of fugitive dust and learn practical methods to do so, such as super up, water and dust suppressant applications (6).

Construction companies are required by set and federal law to implement a diligent concern to control dust pollution. If at any time violations are committed, these companies will be subject a fines and penalties. This has been yet another quandary companies have had to face on a regular basis. The penalty policy held by the Maricopa County Air Quality Department seeks to prevent future violations. Fines that are placed upon companies are certain by the severity of the violation committed. Several factors are traditional to calculate the amount of a penalty. In case there has been an economic aid of noncompliance by the company, the penalty will consist of weighing out the benefits that were looked to have been extracted.

Dust control compliance has also become a financial setback for construction entities. The Maricopa County Air Quality Department announced that in the month of October $452,589.90 in air quality violations was peaceful (9). In the month of September, the amount of $471,613.30 was unruffled in violations all related in one diagram or another to air quality control. This is the grief construction company’s face for not correctly using effective measures to cleave dust in the construction sites, therefore causing potential problems to approach residents and workplaces, eventually becoming a financial predicament due to fines.

There is no better diagram to understand how troublesome the strict regulations have become a burden for construction companies. While searching for construction companies within the valley, Turner Construction Inc. drew attention as it is well known as a titanic construction company that has a corporate office in Tempe, AZ. With a inquire to philosophize to a construction manager, a brief conversation was held with a construction project manager from Turner Construction. The conversation revolved around how Valley Fever has affected their procedures during construction or related tasks. Immediately it became positive objective how worthy companies who are in the construction industry are affected by laws to attend slice the incidents of Valley Fever. Jason Jones, who is a project manager at Turner Construction Company, explained that all construction companies have been hit hard by Maricopa County. Amongst the things mentioned was the fact that the main anguish for the county is dust control. As a result for the growing misfortune over dust control, they have to follow a “rigorous dust program” to comply with regulations. Jason explained how they are currently working on a 242 acre development complex and have had to exhaust around 400,000-750,000 gallons of water to control dust governed by Maricopa country. He added that this adds to the costs of the construction project as trucks and workers are broken-down to acquire fugitive dust. If they ever do not comply with these regulations, fines inaugurate from about $1,000 to 10’s of thousands of dollars. He added that Maricopa is the “worst county in America for dust regulations” (8).

The main pickle is that construction companies have to follow strict regulations on their dust production. The county of Maricopa has been enforcing even stricter laws to prevent and assist possess dust levels to a minimum as they have recently been under serious scrutiny from the Environmental Protection Agency. If for some reason these companies are not correctly using effective measures to cleave dust in the construction sites, stout fines will follow. This is yet another direct companies are dealing with. To the load even greater, these companies also deal with the economical plot backs from following these regulations. For companies to slash and comply with county regulation, thousands of dollars are being forcefully spent by such companies. The contributions construction companies acquire to Valley Fever is not underestimated. As a result, strict regulations are followed and posed upon companies to nick the incidence of Valley Fever cases. Valley Fever has approach to cost companies thousands of dollars and is becoming every day more of an grief.

Conclusion

After studying the stakeholders alive to in Valley Fever, it is easy to glance accepted themes between them. There is no doubt that while not known as a perilous disease, Valley Fever has the potential to be one. With the number of cases increasing each year and relatively cramped research being done for prevention and cures, Valley Fever has earned the title as an emerging epidemic. While Coccidioides immitis only lives in a few pick areas of the United States, it poses a threat to people throughout the country due to the increasing popularity of visiting and engrossing to endemic areas. It also must not be forgotten that Valley Fever has the capability to affect animals as well humans increasing the cost of the disease for these species. It is certain that because of this, action must be taken in order to lop the number of cases and to decrease the severity of the cases.

This case discover points to a few relatively easy steps to buy in order to decrease the severity of Valley Fever cases. The most distinguished and most definite step is early detection. It was shown that the earlier that the disease is diagnosed, the less severe the symptoms and the less impact it has on the infected individual. Despite this easy solution, doctors saw their patients and average of three times before they tested for Valley Fever and the patients on average waited 44 days before treatment. These statistics point to a general lack of awareness this disease in both the patient and the medical world. In order to promote early detection, there must be better instruction of symptoms and complications keen in prolonged disease available to both the medical community and the population of endemic areas. This in theory would build an awareness of the disease and back earlier testing for it.

There are a few steps that can be taken in order to lop the number of cases of Valley Fever. As well as promoting early detection, public awareness of the disease could also succor slice the number of cases. Public awareness of Valley Fever would chop the number of cases by providing the people with knowledge of its causes and ways to avoid exposure to the Coccidioides immitis spores. The second step that should be taken is a national focus on research in vaccines and cures for this disease. From this case behold it is determined that contracting this disease could potentially be very costly. The financial burden will then be on either the infected individual themselves or on the location in some circumstances. These high costs are unacceptable when relatively runt investment is being made in the research of a cure or vaccination.

When considering these recommendations, it is indispensable to review the facts about this disease. Valley Fever is caused by the spores of a fungus that can become airborne when soil is terrorized. This fungus is endemic to expansive portions of the American southwest including Phoenix, Arizona, the nation’s fifth largest city. Statistically, anyone living in endemic areas is likely to gather this disease at least once in their lifetime. On top of those living in endemic areas, those visiting the set have a high chance of contracting the disease. The number of cases has risen consistently each year for at least the last seven years. After reviewing these facts it is certain that Valley Fever has had a principal impact on our society and that steps need to be taken to slice its prevalence.

References

Introduction

(1) Chuang, Amy. “Disseminated Coccidioidomycosis in an Immunocompetent Person Living in Original York City”. Journal of Urban Health: Bulletin of the Recent York Academy of Medicine, Vol. 82, No. 2, doi:10.1093/jurban/jti057

(2) Comrie, Andrew C. “Climate factors influencing coccidioidomycosis seasonality and outbreaks. Environmental Health Perspectives. June 2005 http://findarticles.com/p/articles/mi_m0CYP/is_/ai_n14816419

(3) DiSalvo, Dr. Arthur. Mycology – Chapter Six Dimorphic Fungi. 21 Nov. 2008 http://pathmicro.med.sc.edu/mycology/mycology-6.htm

(4) McKinley, Jesse. “Valley Fever hits epidemic numbers from Texas to Northern California”. Original York Times. 30 Dec. 2007 http://www.sfgate.com/cgi bin/article.cgi? f=/c/a/2007/12/30/MN12U6OGF.DTL&feed=rss.news

(5) Smith, Scott. “MedlinePlus Medical Encyclopedia: Coccidioidomycosis.” National Library of Medicine – National Institutes of Health. 9 Oct. 2006. 22 Nov. 2008 .

Medical Industry

(1) “Coccidioidomycosis..” NGC – National Guideline Clearinghouse . 1 Nov. 2005. 2 Nov. 2008
(2) Smith, Scott. “MedlinePlus Medical Encyclopedia: Coccidioidomycosis.” National Library of Medicine – National Institutes of Health. 9 Oct. 2006. 22 Nov. 2008 .

(3) “Valley Fever – Valley Fever Connections.” Valley Fever – Valley Fever Connections. 22 Nov. 2008 .

(4) “Valley fever – MayoClinic.com.” Mayo Clinic medical information and tools for healthy living – MayoClinic.com. 15 Mar. 2008. 22 Nov. 2008 .

(5) Interview Roni Cummings, Quality risk management: Notes in hand

Infected Individuals & Insurance Companies

(1) Arizona Department of Health Services. (2008). Valley Fever Annual Relate 2007 (1^st ed.). Phoenix, AZ: Arizona Department of Health Services, Division of Public Health Services.

(2) Interview with Anonymous Patient #1: Patient “V”. (Personal Communication, November 15, 2008).

(3) Interview with Anonymous Patient #2: Patient “F”. (Personal Communication, November 17, 2008).

(4) The Associated Press (2007, January 11). Ariz. Valley Fever Cases Soared in 2006. The Washington Post. All Pages.

(5) Unknown Author. (2008, October 29). Arizona Company Seeks Valley Fever Cure. BIO5 Institute News Archives. All Pages.

(6) Arizona Department of Health Services Webmaster. (2008, November 3). Infectious Disease Epidemiology. Retrieved November 15, 2008, from http://azdhs.gov/phs/oids/epi/disease /cocci/index.htm

(7) Author Unknown. (Last modified October 30, 2008). How Pre-Existing Conditions Work. Retrieved November 15, 2008, from http://health.howstuffworks.com/pre-existing-condition.htm

(8) BIO5 Institute at the University of Arizona. (2008). BIO5 Institute Home Page. Retrieved November 15, 2008, from http://bio5.arizona.edu/index.php

(9) Pfizer Inc. (Unknown Date). Pfizer Products. Retrieved November 15, 2008, from http://www.pfizer.com/products/rx/rx_product_diflucan.jsp

(10) Roerig, Division of Pfizer. (Last revised March 2008). Diflucan (LAB-0099-10.0). Retrieved November 15, 2008, from http://media.pfizer.com/files/products/uspi_diflucan.pdf

(11) The Mayo Clinic. (2006, March 17). Diseases and Conditions Valley Fever. CNN.com & MayoClinic.com. Retrieved from http://azdhs.gov/phs/oids/epi/disease/cocci/index.htm

(12) The University of Arizona. (Video Production). (2008, March 8). Innovation Day at UA 2008, UA @ the Leading Edge [Episode 1]. Development of the Valley Fever Vaccine. Video retrieved from http://www.youtube.com/watch? v=kgT0hFo49G4

(13) Valley Fever Center for Excellence at the University of Arizona. (2003). Valley Fever Center for Excellence: Coccidioidomycosis. Retrieved November 15, 2008, from http://www.vfce.ar izona.edu/

Infected Animals

(1) Mitchell, Chris. Blastomycosis, Cryptococcosis, Coccidioidomycosis (Valley Fever), Histoplasmosis, Disease and more. Animal Shelter Org. 2004. November 4, 2008.

(2) Valley Fever (Coccidiodomycosis). Mar Vista Animal Medical Center. 2006. November 5, 2008. http://www.marvistavet.com/index.html

(3) Valley Fever in Dogs. Valley Fever Center for Excellence. 2008. October 18, 2008.

Construction

(1) “Valley Fever” 1998-2008 Mayo Foundation for Medical Education and Research. Outbreak grips Arizona. March 17, 2006

(2) Benjamin J. Park, Keith Sigel, Victorio Vaz, Ken Komatsu, Cheryl McRill, Maureen Phelan, Timothy Colman, Andrew C. Comrie, David W. Warnock, John N. Galgiani, and Rana A. Hajjeh. “An Epidemic of Coccidioidomycosis in Arizona”, 1998-2001. The Journal of Infectious Diseases, 2005. 1 June.

(3) U.S Environmental Protection Agency. The tidy air act amendments of 1990. Clean Air Act. November 10th, 2008.

(4) MAG 2007 Five Percent Thought For PM-10 For The Maricopa County Nonattainment Status. December 2007. Maricopa Association of Governments. < (www.mag.maricopa.gov)>

(5) Maricopa Air Quality Department. (2008). Dust Control. [Brochure]. Dust Compliance Resources Maricopa County.

(6) Maricopa County Air Pollution Control Regulations, Regulation III-Control of Air Contaminants Rule 310.

(7) Toribio, Jeovanny. “Maricopa County and dust regulations‏.” E-mail to Erin Dunsey. Oct. 21, 2008.

(1) Jason Jones, Turner Construction Inc, Oral interview, Done 10-21-2008

Notes in Authors hand

(2) Maricopa County Air Quality Department. “Air Quality Violators pay over $452K in October”. November 3, 2008. News.

Valley Fever is the favorite name for the disease called coccidioidomycosis caused by the fungus Coccidioides immitis(2). This fungus grows in the San Joaquin Valley and south central California, Arizona, Current Mexico, western Texas, southern Nevada, the south western corner of Utah, and northern Mexico (1). First reported in the United States in 1894, Valley Fever was officially declared an epidemic by the Arizona health department in 2006 after 5,500 cases were reported that year, including 33 deaths (3). In approximately 60 percent of the time the infection is asymptomatic and the host has no conception that they had contracted it. The other forty percent collect symptoms ranging from unruffled to severe, including death. This emerging disease has had a enormous do on the human and animal populations in the endemic areas.

When soil containing these fungal spores is stupefied they become airborne and can be inhaled by humans and animals. This disturbance can be caused by anything from humans digging and animals playing in the soil to dust storms and earthquakes. Immunocompromised patients, young children, the elderly and members of several ethnic minorities have a higher risk of contracting Valley Fever (4). Although these groups have a higher level of risk, coccidioidomycosis has been known to affect a wide range of individuals from prison inmates and archaeologists, to drug sniffing dogs along the Mexican border. In unique years, cases in prisoners at a California Central Valley correctional have reached as high as 1 inmate in every 10 tested (4).

The considerable things to understand when learning about this disease are its cause, what is being done to prevent and cure it, its prevalence, and risk factors. This paper has been assembled to address these issues regarding Valley Fever. This paper focuses on four main stakeholders in this Valley Fever epidemic, the medical industry, infected individuals and insurance companies, infected animals and construction companies.

Medical Industry

Valley Fever is a respiratory disease caused by airborne fungi spores from Coccidioides immitis that enter and grow inside the lungs and cause infections. About 60% of the people do not realize that they have this disease because it can cause no recognizable symptoms and can only be positively identified by a skin test. The 40% of the remaining population can win composed to severe symptoms. The disease can manifest in three different types of forms; acute, chronic, or disseminated. Each beget ranges from minor to severe consequences. Most indispensable of all, is to know what the symptoms of Valley Fever are. There are ways to sigh if someone might be infected and those symptoms include chest pain-which is a constriction that makes it difficult to breath, fever, muscle stiffness, joint stiffness, wheezing, cough, loss of appetite, chills, and change in mental space. Those symptoms appear any where from 10-30 days after exposure to the spores. After one or two weeks some people will commence to effect painful rashes and or lumps on the lower state of the legs. Symptoms that can be linked with the disease once contacted include joint swelling, joint hurt, arthritis, ankle, feet, leg swelling. All of theses symptoms may not accrue in everyone and can vary from unexcited in some people to severe in others. Showing more then one of these symptoms should be a pleasurable indicator that the person has contracted the disease and should consult a doctor.

Once a body is infected, Valley Fever will reveal up in one of three forms acute, chronic, or disseminated. Some of the forms are more rare then others. Depending on the compose that Valley Fever takes, the severity of the effects on the body and how risky it can be will vary. The acute develop is rare and about 3% of the people that live in places with coccidiomycosis found in the dirt, will reveal the development of the disease. This can happen at any time during the year or any season. It affects both men and women equally and the systems will go like the body has caught the flu. Chronic construct is rarer and less popular then the acute build. It is more perilous than the acute design and can cause more problems. The chronic create can become evident and obtain after 20 or more years from when the person first got the infection. This may not have been found, treated, or even discovered by the person with the disease.

Valley Fever can cause infections in the body and accomplish lung abscesses. These abscesses can pop and erupt, releasing pus into the lungs. This pus then travels to the pleural area or the spot between the lungs and the ribs. This can cause serious injure to the lungs and the person will have a difficult time breathing. Other symptoms include crude grade fever, weight loss, and nodules in the lungs. The disseminated make is the most uncertain and severe out of the three. This is when the disease spreads to the different parts of the body. The infection gets into the person’s bones, lungs, liver, meninges, brain, skin, heart, and around the heart. It is found that 30% to 50% of those people infected with this get also rep meningitis. This produce can be very deadly as it can cause swelling around the brain and spinal cord. With this build, healthcare providers often peruse ulcers and skin lesions, painful lesions in the skull and spine or bones, and painful, swollen joints. This is a life threatening get and can cause death if not treated correctly. It can cause brain pain as well and can affect the brain/mental plot of the person.

Everyone in the world is different and so not every person is going to be infected the same plot. People of different color or hurry can contract the disease more readily then others of another bustle can. The people of Asian, Hispanic and African descent are more susceptible to the diseases than Caucasians. Even though it is really unclear why, those of color are 10-20 times more likely to salvage the disease. Most cases that ended up in the emergency rooms were of Hispanic or African origin. Other people that have a high infection rate are people that are diabetics or weakened immune systems such as those with AIDS. Also women that are pregnant, in their third trimester or apt after their babies are born, are at an increased risk of getting Valley Fever. All of these factors will form it easy for them to accept the disease because their bodies can’t resist the initial infection. As well as with the lower immunity’s the body can’t fight succor as well causing them to pick up worse quicker and will be more severe. Age is a substantial factor as well seeing as older adults have a higher chance of developing Valley Fever then an younger age. This is because their immune systems are less active or have other medical conditions that lower their ability to fight off the infection. Individuals with archaic immune systems are at higher risk for complications which may lead to the disseminated beget. It lets the disease spread easier through out the body and lets it glean into the notable systems of the body. This can form the body more susceptible to other types of infections because of the further weakening in the immunity from Valley Fever.

Valley Fever, as stated, gets stirred up into the air from unusual construction or gardening, allowing one to breathe it in. Once it gets into the lungs it sticks in the inner allotment of the lungs. There it will grow and multiply inside the lungs. Depending on what accomplish it takes it can certain up from there or release pus. This pus then can secure absorbed into the body and stick to different types of organs. It can especially target places where it can beget up in such as joints, feet, and legs. This is because the fungi regain into the blood stream which will acquire absorbed by muscles, bones, and under the skin where it can deposit and grow. If the immune system is not strong enough, it can not demolish the infection which allows it to further mitigate as it builds in different spots of the body. Since it goes into the body’s blood stream it can pick up to where ever the blood is flowing. This includes vessels around brain and the spine. This will cause different reactions such as the person affected might lose some perception and awareness because of the lack of spruce blood being given to the brain. With the fungi being deposited in places such as the feet or skin it causes swelling because it will do liquid or more pus-like substance. This will cause the joints to swell up because of excess liquid causing arthritis. Besides looking at the symptoms of the person there are many other ways to decide if there is a Valley Fever infection. Different medical professions expend different ways to resolve the infection in the body and depending on the degree of the disease.

A chest x-ray can be taken to figure out if one is infected. In the x-ray the doctor would be looking for light areas in the lungs that are poorly defined or patch areas. The spot where disease is growing will point to up usually approach or next to the ribs as most of it grows and deposits there. A skin test can be given as well and it is called the spheriulin skin test. This test looks to seek if the person is infected with the fungus and since it is more sensitive it can bewitch up signs of an earlier infection accurately. Spheriulin is an antigen that is connected with the fungi that causes Valley Fever. This substance is injected impartial a cramped below the skin, preferably in the forearm similar to a TB (PPD) test. Then the doctor will spy at the arm or the dwelling it was injected at 24 and 48 hours after the test. If the body has antibodies to the fungus, and it is in their system, the body with react and the place will become red and swollen. Although this test is not being broken-down as mighty anymore because it is not as specific, it however is outmoded in researching to understand the disease. A more current test is a sputum culture. This is where the doctor or nurse retrieves sputum from the patient. Sputum is the mucus-like secretion in the bronchi tubes or where the air goes to the lungs, and comes up with deep coughing. The doctor or nurse will ask the patient to cough deeply and spit up any sputum into a sterile cup. This will be taken to a lab that allows it to grow to contemplate if Valley Fever is expose. The doctor my tap on the chest or have the person inhale steam-like mist to benefit cough up the sputum in order to score a better sample. One of the last tests that may be done is a coccidiodes antibody test. This test is where the blood is taken to analyze if there are any antibodies to the fungus in the body. If the antibodies are prove it can mean that there is an ongoing infection or a prior one. The test and blood may be taken a couple of weeks after to survey if there is a rise in the antibody count which determines the infection and how severe it may be. The higher the titer or antibody counts the worse the infection it is. These are all tests that the doctors may employ in determining more accurately if the disease is show in the body. This is the only plan to be 100% certain that there is an infection.

Depending on the magnitude of the infection different treatment options will be provided by the doctors. Some of the forms may even dissipate with no medical interactions as well. The acute disease will usually go away without medical intervention. Favorite management is bed rest and treatment for flu symptoms until the fever goes away. With any of the other forms, medication would be needed to capture care of the disease. If the dilemma persists or if there is a higher possibility of complications and it is in its more severe earn, antifungal medications would be required to be taken. These medications would include amphotericin B, ketoconazole, fluconazole, or itraconazole. In a chronic perform or more acute invent that won’t go away, amphotericin B is usually the medication given to succor fight off the disease. Then the person is monitored as to effect positive the condition does not worsen which might last from a couple months to a year. Surgical action may be an option to win care of lesions that are localized. For the disseminated compose fluconazole or itraconzole is commonly mature. The dosage is usually 400mg per day and in some cases 2000 mg of fluconazole or 800mg of itraconzole per day may have to be taken in 200mg doses. Amphoterican B may be venerable as an alternate in this site if lesions are getting worse more quickly and is aged to diffuse pneumonia. Surgery is significant in this case and in most reports at this stage it is principal. This is old to grasp care of sizable abscesses, destructive lesions or bony sequestrations instability of the spine or the movement on famous organs such as the heart or tissues such as the spine. Since this do is the worst and in most of the time fatal more actions are required in recovery as compared to the more acute forms. Treatment of the disease does not acquire it go away for expedient as relapses can occur or the person can rep it again.

The disease can have short affects and long term effects on the body. Depending on the person or the amount of spores inhaled, this will decide the longevity and affects of the person. The short affects include flu like symptoms and will go away. It is an annoyance unbiased like any time someone gets sick and the person can go on with their life with no distress. These people probably have higher immune systems. However, the longer the disease stays around in the body the more damage it will do. If it is prolonged in the body for an extended time it will launch having more harsh affects on the body. The infection can spread to the bones in the body and cause deterioration or holes in the bones. This will stop with the patient through out their life. If it is in the body for the extended time it can cause variations of getting better then getting worse fluctuations as well as can cause relapses of the disease where it can reach aid. If not treated, the non-acute gain will worsen over time and in most cases rep into other organs of the body and fabricate the disseminated type. Taking care of the infection early on would be a suited strategy as Valley Fever can cause death if not treated at the fair time. If the disease is prolonged it can cause other diseases or illnesses. These include forming pneumonia and meningitis which obtain the condition that great more deadly and difficult to treat. As both of those diseases are fatal as well and can earn awful mixes with Valley Fever. Bleeding and lung abscesses could build which have to be medically treated and in some cases have to be done with surgery. Prolonged exposure can effect the person at outrageous discomfort as the pus gets into the lungs and fills the lungs making them feel like they’re drowning and can’t breathe. This can cause many abominable effects as the body can’t win enough oxygen into the body. People that already have respiratory problems such as asthma can be compromised and hinder the lungs from working efficiently. This can cause a more acute construct such as short of breath to something more unsafe as not getting any air in and finish breathing without medication or immediate treatment. Most importantly the disease should not be taken as lightly as it can cause death if overly prolonged or gets into its most hazardous forms in the body. Many problems and complications would have to happen in order for it to win to that severe of stage. As long as the disease is recognized and treated (if need be) then the affected person can easily recover.

Many people who have Valley Fever don’t even know they have had it because the severity changes in everyone and 40% of the people would indicate symptoms and require exiguous to major treatment. This disease changes over longer periods of time. A person may have some time to go peruse a doctor before they feel the severity of the disease. Though, as stated earlier, waiting for long periods of time to search for medical care would not be reliable to one’s health. This disease is taken in most of the medical field taken very lightly even though misdiagnosis and prolonged exposure to the disease can be fatal to the person’s health. It can have affects on the body that stop with them for years at a time or even there entire life. This is something that if in ask consulting a doctor would be the best course of action so treatment can start so complications don’t arise.

Infected Individuals & Insurance Companies

There are many primary stakeholders that would be affected, at least in some capacity, if an executive decision were to be made with regards to the remark of Valley Fever. Arguably, the role of infected persons or those that occupy a novel vulnerability to the disease is top priority on the decision-maker’s list. Each year, thousands of people are diagnosed with Coccidioidomycosis in Arizona alone. In a 2007 article, the Washington Post wrote that Valley Fever cases diagnosed in 2006 were up fifty-six percent from a year earlier. This prompted Arizona health officials to heed the disease at, “epidemic proportions,” as thousands of other cases likely went undocumented. It has also been reported that anyone who has spent enough time in Arizona, or any other fraction of the Southwestern United States where soils occupy the Valley Fever fungus, will contract the disease at some point. Only a shrimp percentage of people, however, are diagnosed with a severe enough accomplish of the infection where medical treatment is needed. Anti-fungal medication is the most popular treatment for Valley Fever. But, there are rare cases where surgery is required to fully recover from the disease. Overall, tens of thousands of cases are reported around the United States annually and the number of Valley Fever-related deaths is estimated at 50-100 each year. It is critical to see individuals currently struggling with the disease as well as those who have recovered from a serious build of Coccidioidomycosis as a stakeholder with regards to this sigh because there exist many factors that affect the lifestyles of those individuals, their families and their friends. In an trouble to better assist this claim, the lives of two patients that contracted a serious originate of the infection, will be addressed and analyzed in the following paragraphs.

Before introducing specific cases, it is well-known to review some novel facts and figures with regards to the disease. The Arizona Department of Health Services released their annual Valley Fever Characterize in October 2008. The relate, co-compiled by the Office of Infectious Disease Services and the Bureau of Epidemiology and Disease Control, presents the amount of Coccidioidomycosis cases reported in 2007 through a myriad of graphs. These graphs affirm the research information in a thorough and comprehensive method to the reader by dividing up Valley Fever statistics for the 2007 year in a multitude of categories. Some of these categories include: cases reported in ‘07 according to specific age groups compared years past and a five-year average, separating the number of Valley Fever cases reported by counties in Arizona, and separating the number of Valley Fever cases reported in both mining and non-mining areas within the residence. Although many people contemplate of this disease as a still illness similar to the celebrated chilly, Valley Fever is a key remark amongst Arizona residents as well as both local and national governments. In 2008, the Arizona Department of Health Services received funds for Valley Fever prevention and control from a legislative appropriations committee. The Center for Disease Control and Prevention (CDC) also awarded the department funds for continued research. As section of the 2007 characterize, Health Services interviewed roughly ten percent of all Arizonans diagnosed with Coccidioidomycosis during that year. According to the ADHS, the following are some of the most alarming facts that were discovered from the interviews:

• People missed an average of 1 month of work, for a total of 4,918 days

• People with Valley Fever could not compose daily activities for an average of 3 months or a total of 92 years

• People with the disease waited an average of 44 days before seeking healthcare

• Patients saw their doctors three times before they were tested for Valley Fever

• There were $86 million dollars in hospital charges for Valley Fever in 2007

Furthermore, Arizona has the highest number of reported Valley Fever cases annually in the United States, accounting for sixty percent nationwide. In total, more than 150,000 people across the country are estimated to contract some invent of Coccidioidomycosis each year. The Arizona Department of Health Services reports that the severity of Valley Fever in the site continues to grow as do the overall number of persons infected each year. Due to the fact that currently there is no cure or vaccine for the disease, every person that is susceptible to the effects of Valley Fever certainly shares some kind of stake in the debates of the shriek. Examining the personal accounts of two anonymous patients afflicted with a serious acquire of Coccidioidomycosis can bring further clarity to this claim. Any and all personal information for the following accounts has either been fictionalized, changed or generalized to absorb complete anonymity.

The first case will inquire of the heinous effects of Coccidioidomycosis on a male patient of early adulthood age. This individual will be referred to as Patient “V” throughout this paragraph. Patient “V” began his ordeal with Valley Fever in the summer months of 2001. A younger man in the final years of adolescence, Patient “V” experienced generic, flu-like symptoms, which he disregarded as nothing essential like most other sufferers determine to do. “At first, I noticed that my lymph nodes in my neck were unusually swollen…I figured it was objective a icy or some little infection or something like that.” Soon after the initial stages of the disease, Patient “V” began experiencing constant, severe distress in the left side of his chest. Although he made numerous medical appointments for this scrape, the injure would subside by the time Patient “V” arrived, making it difficult to diagnose the spot. “What was happening was my left lung had a hole in it and it kept collapsing and then re-inflating by the time I got to the doctor’s office.” Eventually, a chest x-ray was performed on Patient “V” and this revealed a tiny, dismal state on his left lung. The situation indicated a relatively dinky, but necessary hole through the lung. The pickle required corrective surgery and Patient “V” was admitted to one of Arizona’s hospitals in August, 2001. Surgeons sewed up the hole in Patient “V’s” left lung and released him after a day of recovery. Within weeks following the surgery, Patient “V” experienced a relapse of his earlier symptoms. “…I was playing Volleyball one night and in an instant, there was this intense damage in my chest…I felt dizzy and could hardly breathe.” Patient “V” immediately returned to the hospital sometime in November of that year where further tests concluded that the infected portion of his left lung was, indeed, Coccidioidomycosis. Another surgery to completely prefer this part of infected lung was performed successfully and Patient “V” spent more time recovering in the hospital. “The effects from the disease itself were painful enough, but the worst harm came from the chest tubes that were inserted into me in the hospital…At one point, they shoved one of the tubes through my ribcage and into my lung and I wasn’t even on damage medication.” Fortunately for Patient “V”, the second surgery was successful and he survived his brush with Valley Fever. In many cases, patients who contract and fend off the infectious spore create up life-long immunities. However, reports have also shown that patients in remission from Coccidioidomycosis can be more vulnerable to a reoccurrence of the disease than those that have never contracted it. Following his surgical recovery, Patient “V” was prescribed an anti-fungal medication called Diflucan, a current drug distributed to sufferers of the infection. Patient “V” was required to purchase this medication daily for 2-3 years. He now receives chest x-rays once a year to check for any returning signs of the fungus. Patient “V’s” scar tissue has also become virtually unrecognizable after nearly a decade of recovery.

The second case to be analyzed will be that of a middle-aged female patient. Appropriately, this patient will be referred to as Patient “F” throughout the analysis. Patient “F” contracted Valley Fever in leisurely 1995. Early symptoms experienced in this patient included chronic loss of breath and grievous joint discomfort. The earn of Coccidioidomycosis contracted by Patient “F” was not diagnosed correctly until 2 ½ years after symptoms began. Before visiting a pulmonologist, Patient “F” was given a chest x-ray, where a mountainous, round nodule was located somewhere on her left lung. The patient was admitted to the hospital in 1998 and underwent a wedge resection, to win the infected allotment (removed in wedge do) of the lung. After the first surgery, Patient “F” was prescribed anti-fungal medication similar to Diflucan at tubby strength for six paunchy months; and then half the dosage for another six months. The patient continued to have fevers following the surgery. She also had an excess amount of fluid in her lung. Patient “F” returned for a second surgery to further well-organized the infected spot and completed another sequence of antibiotics afterwards. The time spent in the hospital for recovery totaled at six days for each surgery. Patient “F” was fortunate enough to have flexible employment benefits to fully recover. “My company provided short-term disability; up to 6 months with 100% pay…I was very lucky.” As far as medical coverage is concerned, Patient “F” had minute out-of-pocket costs through United American. However, she was quiet alarmed to recognize the total amount owed from her discontinue in the hospital. “The bill after six days in the hospital, which included one day in ICU and five days on a regular floor, was incredible. Fair for room and board and a exiguous medication, the bill was $28,000.00.” Today, Patient “F” has fully recovered from the infection and only has one suggestion with regards to the announce of Valley Fever. “Educate physicians on the east flee and west glide, all over the Untied States to properly test for Valley Fever.”

Needless to say, there are always financial burdens associated with any type of surgery as well as prescription medication. In the case of Patient “V”, a total of nearly $180,000.00 was accrued in hospital bills after the two surgeries were performed. Additionally, the drug Diflucan can range from 36 dollars to 60 dollars for 100mg/10 pills depending on the area of occupy. It is considerable to see medical insurance companies as a stakeholder with regards to the declare of Valley Fever as well. Because there is no cure or vaccination for the infection, insurance companies limit the amount of coverage to persons with preexisting conditions. If a cure were to be developed and released into the market, insurance companies would most likely include Valley Fever coverage into any concept. Unfortunately, without medical insurance, the overall amount of money needed to recover from a serious infection like Valley Fever is simply insurmountable for the majority of Americans. Even with sufficient medical insurance, however, people who have had Valley Fever in the past are typically not covered for a relapse of the infection. Patient “V” currently receives individual health insurance under a PPO from Blue Sinister Blue Shield of Arizona. As mentioned earlier, however, major insurance companies like this one tend to limit coverage to individuals with preexisting conditions. According to an article on www.howstuffworks.com, a preexisting condition is a health condition or illness that you have had before your first day of coverage on a current idea with an insurance company. Typically under group coverage, such as that offered by a corporation under an employee’s benefits, a person with a preexisting condition can get stout coverage, but will have to wait anywhere from nine months to a year before it kicks in. This period is enforced by insurance companies to insure that a patient is not constantly having relapses of the same condition. However, a person with a preexisting condition will rarely receive private health coverage that includes their condition. This is referred to as the preexisting conditions exclusion. Our attempts to contact major medical insurance companies or medical insurance agents for further clarity on this lisp went unanswered. Unfortunately, people like Patient “V” who have preexisting conditions, are self-employed and do not qualify for group medical insurance will have to pay out-of-pocket if their conditions return. “I would have to speak bankruptcy if that happened…” Patient “V” explained. “I live in apprehension because I know that if I were to secure it again, that would be disastrous.”

Currently, a vaccination for Coccidioidomycosis is under development at the BIO5 Institute on the campus of the University of Arizona. Leading the development is Dr. John Galgiani, Director of the Valley Fever Center for Excellence and Chief Medical Officer for Valley Fever Solutions, Inc. This vaccination will be intended for both humans and dogs, which can also contract deadly forms of Valley Fever (this topic will be further discussed in later sections of this glimpse). In March, 2008, Dr. Galgiani teamed up with fellow BIO5 colleague Dr. David Nix of the Department of Pharmacy Practice and Science to research the vaccination. “We had some complimentary expertise and mine’s mainly in the position of drug development and drug development science and so on. And Dr. Galgiani is kind of the world’s expert on Valley Fever,” Dr. Nix reported in a 2008 Valley Fever instructional video produced by the University of Arizona. The two physicians, under the company name Valley Fever Solutions Inc., are financially backed by the University, private donors and C-Path, a Unique York based foundation. They are currently testing an anti-fungal called Nikkomycin Z, which was first customary to prevent fungal degradation in create. With approval from the U.S. Food and Drug Administration, Nikkomycin Z is in Phase 1 of drug safety trials. According to a news release published on the BIO5 Institute’s website, “The company has already obtained a Science and Translational Technology Research (STTR) grant from the National Institutes for Health that will wait on fund pharmacology studies that will befriend fabricate future clinical trials. The first phase of that grant is worth more than $100,000, with the potential for an additional $700,000.” If this vaccination proves to be a viable cure for Coccidioidomycosis, many aspects of the explain of Valley Fever would certainly change. Once a cure hits the market, the number of deaths and serious cases as a result of Valley Fever would descend significantly. Debates between the government, politicians and special interest groups would decrease as well if no one were in any trusty threat of the infection anymore. Briefly returning to the topic of medical insurance, people with Valley Fever as a preexisting condition will be able to feel more collect because of the availability to a cure, and possibly insurance that covers that cure. Major medical insurance companies like Aetna, Blue Wicked Blue Shield, Cigna and Humana will more freely distribute chunky coverage in instances of Valley Fever. Like most vaccinations and cures to celebrated infections or diseases, there would be many certain outcomes to releasing this drug into the medical market, pending the completion of all drug safety trials.

As famous stakeholders with regards to the yell of Valley Fever, both infected persons and medical insurance companies would be greatly affected if an executive decision were to be made, or possibly a vaccination released into the market. While the future looks trustworthy with regards to a feasible solution to the Coccidioidomycosis fungus, it is imperative that all people salvage a map to score health insurance coverage to some capacity. It is also principal that individuals with preexisting conditions that aren’t on group medical plans lobby for their rights to complete insurance coverage. In considering the cross effects of Valley Fever, there are many people who consider this topic is honest as distinguished to the animal world as well.

Infected Animals

Valley Fever does not only affect people but it is now more commonly being found in animals. Animals are impartial as likely to obtain Valley Fever as humans are. Animals glean Valley Fever in the same device as humans do, by breathing the fungus. It has been found that more and more animals are being reported of becoming ill due to this fungus. It has been found the 30-40% of animals who breathe in the fungus acquire sick. Some of the most popular animals to be reported with Valley Fever are dogs, cats, llamas, non human primates, horses, and zoo animals (3).

A golden retriever went into the vet’s office; the dog wasn’t feeling well and wasn’t acting himself. The vet takes an x-ray of the dog’s lungs and sees white spots in the lung location where there should normally be unlit patterns. The white spots prove that the dog might have cancer in its lungs. The dog is only four years ragged, which is when a dog should be at its prime and not getting lung cancer. Lung cancer isn’t usually found at this young of an age and doesn’t seem to acquire as quick as it has in this golden retriever. The owner had said unprejudiced two weeks prior to going to the vet that the dog was fleshy of energy on their vacation. The veterinarian doesn’t all the facts add up for the dog to have cancer so she decided to speed a few more test before she starting treatment for lung cancer. The dog’s health over the course of time starts to go downhill and very speedily. The dog starts to cough, has a loss of appetite, and cramped to no energy. The vet then found out where the human family had recently traveled and they were in the Southwest. After hearing this, the vet distinct that it must be a fungal disease and it was unbiased that, it was Valley Fever (1).

Dogs are the largest infected and most commonly reported animals with Valley Fever. Dogs obtain Valley Fever in the same plot that humans do and in the same regions as humans do. The fungus is spread through spores which dogs can easily inhale. Once the fungus is inhaled, the spores grow into spherules which enlarge and eventually burst into hundreds of endospores (3). This causes the spreading of the infection into the lungs. A dog’s immune system should answer and surround the infection to slay it. Dogs that do not become sick due to the fungus are considered to be asymptomatic (2). When a dog does become sick from Valley Fever, their immune system fails to ruin off the infection and the infection continues to spread into the lungs and then can move throughout the dog’s body (3).

Once a dog is infected with Valley Fever, there are obvious symptoms that become exhibit. Some of the symptoms that are seen in dogs are weight loss, coughing, fever, lack of appetite, and lack of energy (3). The cough in dogs can be seen as early as the first week of getting the infection to as slack as 3 weeks. The cough that dogs accumulate is due to the development of pneumonia which is visible on x-rays. The coughing can be caused due to pressure on the lymph node come the heart and puts pressure on the dogs windpipe which as a result irritates it (3). After the cough is show the loss of appetite and energy is soon to follow. If the infection is not controlled it can become remarkable worse and spread throughout the body. When the fungus is spread throughout the body it causes systemic or disseminated disease (3). When this happens the symptoms and condition of the dog becomes powerful worse. The symptoms that become expose are: swelling of the limbs, serve and neck damage, seizures, soft swelling under the skin that resembles abscesses, swollen lymph nodes, see inflammation, and non-healing skin ulcerations (3). Not all symptoms are indicate good away and it can prefer several months before definite symptoms appear. It can be several months after a cough appears that other symptoms become display. There is typically an order that the fungus spreads throughout the dog’s body. The first organ to be effected is lung, and then the infection usually spreads into the bone, than eyes, heart, testicles, brain, spinal cord, and finally abdominal organs (2).

To settle if a dog has Valley Fever there are different test that can be done. Some of the most approved test done to choose if a dog has been infected is blood tests, chest x-rays, bone and joint x-rays, and Valley Fever blood test (3). Test results may exhibit up negative up to 3-4 weeks of receiving the infection so in some cases test need to be repeated to confirm that the dog does or does not have Valley Fever (2).

There are different treatments that be done to assist fight the fungus. The process of treating Valley Fever may be long; medication can be given for up to one year (2). The length of time that the treatment will seize usually depends on how far the fungus has spread throughout the body. Most commonly oral antifungal medication is given to the dog. These antifungal medications are ketoconazole, itraconazole, and fluconazole (2). Ketoconazole is the most commonly prescribed medication due to the fact that is it the least expensive. This drug is usually given twice daily and with food. Itraconazole is a more expensive medication but has fewer side effects than ketoconazole. Itraconazole is also better for dogs that are having problems keeping their food down because it has a faster absorption rate (3). The third medicine most commonly given out for treatment is Fluconazole and it is also expensive with microscopic side effects. This is usually given to dogs that have afflict done to their spinal cord and nervous system (3).

Cats, llamas, non human primates, horses, and zoo animals are other animals that have been reported with Valley Fever. Cats that have Valley Fever display the same symptoms as dogs do but it less likely for a cat to gather Valley Fever than it is for a dog. Cats net Valley Fever about every 1 case compared to 50 cases in dogs (3). When cats procure the fungus their symptoms are usually a microscopic more advanced than dogs. Two of the major symptoms seen in cats that have Valley Fever are unexplained weight loss and skin ulcerations that won’t go draw. The same treatment for dogs can be extinct to treat cats with Valley Fever (3).

Horses are another animal that have been found to win Valley Fever. There have not been very many cases reported but in the ones that have only one horse has survived Valley Fever with treatment. All the other horses that were reported with Valley Fever had to be euthanized. The reports of these cases are not very unique though, and with medical technology improvement chance of survival with unique medicine is mighty better for horses today (3). Llamas are another animal that have been infected with Valley Fever. Llamas are very sensitive to this fungus. In most cases, if a llama has Valley Fever death is almost always the outcome.

Zoo’s that are located in the Southwest are very aware of Valley Fever. Many zoos have lost animals due to Valley Fever before they were aware of what is was and how to treat for it. When animals become sick, Valley Fever is something that is tested early so treatment can be started. In zoos, the most current animals to net Valley Fever are: Monkeys, Apes, and other primates. These animals expend the same treatment process as dogs and cats but is usually consists of a lifetime treatment (3).

Valley Fever is a very serious squawk that is rising in animals. Currently there are no preventatives for Valley Fever. The treatments for Valley Fever for animals has become better and better over time. The come in technology has allowed for veterinarians to be able to detect Valley Fever at a less arrive stage. The early stage that Valley Fever is caught at allows for a better chance of survival of animals infected with the fungus.

Construction

There is no doubt that construction companies contribute significantly to Valley Fever. According to the MayoClinic, institution known for prominence in the medical field recognized the increase in sincere estate has contributed to the spew of “thousands of tons” of dust carrying this fungus into the air. The article looks at how in the 1990s the accounts of Valley Fever increase in the states of Arizona and California due to some important factors. Among those factors like dry climate, the unusual building booms have been one of the most considerable factors that have contributed to such increases. The fleet clearing and building were a notable source for the increase in reported cases of Valley Fever. Among all the contributing factors of Valley Fever, environmental exposure ranks high, if not the important cause. Experts also added that almost half of the people who live in areas where Valley Fever is prevalent have contracted the disease. Interestingly, people who are at most risk are those who are exposed to directly to dust like those who construct jobs in the field of construction, ranching and agricultural work (1).

The decade following the 90’s has had a vast increase in reported cases of Valley Fever. Those areas that have reported such increases are the states of California and Arizona. These states have been induced with a massive building disclose. The mass migration to these “sun belt” states made for a widespread land clearing and construction, which ultimately directly contributed the spread of the air borne fungus (2). Importantly, some measures are currently in state to purposely gash the amount of dust construction companies contribute to the environment.

The Environmental Protection Agency (EPA) is an agency of the federal government of the United States who is in charge of protecting human health by maintaining the natural environment beneficial (3). This implies its commitment and dedication to monitoring and posing regulations for anything threatening the quality of the air. The EPA has residence limits on how noteworthy pollution is allowed to be in the air. In its goal to possess and manage the air we breathe, EPA has passed several pieces of legislation that have reduced the amount of smog and pollutants in the air. Among indispensable legislation is the Shipshape Air Act which has been passed to enforce orderly air standards and improve human health. The Well-organized Air Act is an outline for what national, plot, and local authorities must follow in order to protect air quality. Under the Well-kept Air Act, local and dwelling authorities are responsible for abiding by the national ambient air quality standards. The Environmental Protection Agency states Maricopa Country cannot exceed the federal health standard for particulate pollution more than three times in a three year period (4).

According to the Environmental Protection Agency (EPA), Maricopa County has been in violation of particulate pollution since 1996. Particularly 2008, there have been nine different days where at least one of the monitors exceeded the federal health standard for particulate pollution. The health standard for particulate pollution is that it cannot exceed more than 150 micrograms per cubic meter measured over a 24 hour period of time. It’s principal to know Maricopa County has 24 air monitoring sites in the Valley. The plot of Arizona, under the Arizona department of environmental quality has its occupy air monitoring sites as well. If any of these monitors exceeds the federal health standard for a given pollutant, the EPA will possess Maricopa County accountable. According to the Environmental Protection Agency (EPA), Maricopa County failed to approach attainment for particulate pollution and thus is under federal orders to slice particulate matter pollution. In an attempt to address the teach, Maricopa County, the Maricopa Association of Governments (MAG) and local cities and towns submitted a concept to the EPA to reveal how the county plans to nick PM₁₀ emissions by five percent each year until grand levels are reached. The Five Percent Belief outlined more than 50 commitments to prick dust. Of these commitments, some affect the procedures and guidelines on construction entities (4).

Speaking with Erin Dunsey of Maricopa County Air Quality Department, the county is currently working hard to pose regulations on construction companies in order to lower dust emissions and ultimately lowering the potential threats from Valley Fever. The principle responsibility for The Maricopa County Air Quality Department’s Dust Compliance Division is to protect the public from the dangers that advance from airborne particulate matter (7). This division of dust compliance deals with fugitive dust sources and the rules to minimize the production of it. This means that fugitive dust from any source, including constructions areas, must be restricted in their construction operations to possess within first-rate dust standards. As allotment of the compliance, Maricopa County has devised that all sites with afraid surface areas of dust must comply with “Rule 310″ (5).

Under Rule 310, the Dust Compliance Division has established limitations and requirements for the implementation of process controls as well as other guidelines that will attend enforce obliging fugitive dust control measures. One of the first major steps for construction companies to follow is the obtainment of a permit. The Air Quality Department requires a construction permit for companies who concept to conduct activities any that will disturb a surface state equal to or greater than 0.1 acre. Complying with the construction permit requirements is often a indispensable and daunting task. Before applying for a permit, a idea that outlines the measures that will prevent the creation of dust must be presented. This thought also describes all the measures that will be implemented at anytime during the phase of construction. Therefore, this guideline requires dust generating sources to meet standards and at the same time apply best the available control measures in order to attempt to minimize fugitive dust emissions. This design being the first of many that have been imposed on construction companies, entitles that all workers or subcontractors on region understand their responsibility while on state (6).

Another hassle that companies have to deal with is the logging of control measures. Once again, under Maricopa County’s Rule 310, construction companies who conduct a dust generating operations that require a Dust Control Idea must preserve a written log recording the right application and execution of the control measures previously outlined and well-liked by the Dust Control Thought. This is a daily detailed recordkeeping which records what actions are being conducted in dust-generating operations in what may include daily inspections for crusted or damp soil. Another allotment of report keeping is the trackout conditions. This rule also requires that all work sites that are more than two acres and absorb terrorized surfaces must install a trackout control devise. These devises are big contributors to the retention of fugitive dust. Trackout is simply the particulate matter from tires and other sources that have fallen onto paved areas that are accessible to the public. The rule states that trackout must be minute to 25 cumulative linear feet (6).

Rule310 is an extensive and overwhelming position of requirements established to lower dust emissions. Allotment 309 list another requirement under Rule310 that companies must abide by. The rule says that if the position of interest is more than one acre a series of dust control training must assume area. All workers directly fervent in the containment of dust like the water truck drivers and water pull drivers must buy a basic dust control training class in which attendees will ultimately become certified if successfully completed the training class. An extension from this fragment lists that a dust control coordinator must be expose on job state if the dimension of the job place is five acres and up (5). These onsite coordinators must have completed a comprehensive dust control training in which they are given fine training on regulating emission of fugitive dust and learn practical methods to do so, such as neat up, water and dust suppressant applications (6).

Construction companies are required by position and federal law to implement a diligent wretchedness to control dust pollution. If at any time violations are committed, these companies will be subject a fines and penalties. This has been yet another predicament companies have had to face on a regular basis. The penalty policy held by the Maricopa County Air Quality Department seeks to prevent future violations. Fines that are placed upon companies are sure by the severity of the violation committed. Several factors are worn to calculate the amount of a penalty. In case there has been an economic back of noncompliance by the company, the penalty will consist of weighing out the benefits that were looked to have been extracted.

Dust control compliance has also become a financial setback for construction entities. The Maricopa County Air Quality Department announced that in the month of October $452,589.90 in air quality violations was tranquil (9). In the month of September, the amount of $471,613.30 was mild in violations all related in one arrangement or another to air quality control. This is the misfortune construction company’s face for not correctly using effective measures to gash dust in the construction sites, therefore causing potential problems to reach residents and workplaces, eventually becoming a financial jam due to fines.

There is no better plot to understand how troublesome the strict regulations have become a burden for construction companies. While searching for construction companies within the valley, Turner Construction Inc. drew attention as it is well known as a grand construction company that has a corporate office in Tempe, AZ. With a put a question to to declare to a construction manager, a brief conversation was held with a construction project manager from Turner Construction. The conversation revolved around how Valley Fever has affected their procedures during construction or related tasks. Immediately it became definite unprejudiced how powerful companies who are in the construction industry are affected by laws to attend sever the incidents of Valley Fever. Jason Jones, who is a project manager at Turner Construction Company, explained that all construction companies have been hit hard by Maricopa County. Amongst the things mentioned was the fact that the main difficulty for the county is dust control. As a result for the growing pains over dust control, they have to follow a “rigorous dust program” to comply with regulations. Jason explained how they are currently working on a 242 acre development complex and have had to expend around 400,000-750,000 gallons of water to control dust governed by Maricopa country. He added that this adds to the costs of the construction project as trucks and workers are feeble to occupy fugitive dust. If they ever do not comply with these regulations, fines open from about $1,000 to 10’s of thousands of dollars. He added that Maricopa is the “worst county in America for dust regulations” (8).

The main predicament is that construction companies have to follow strict regulations on their dust production. The county of Maricopa has been enforcing even stricter laws to prevent and back hold dust levels to a minimum as they have recently been under serious scrutiny from the Environmental Protection Agency. If for some reason these companies are not correctly using effective measures to slice dust in the construction sites, tall fines will follow. This is yet another say companies are dealing with. To the load even greater, these companies also deal with the economical spot backs from following these regulations. For companies to prick and comply with county regulation, thousands of dollars are being forcefully spent by such companies. The contributions construction companies fabricate to Valley Fever is not underestimated. As a result, strict regulations are followed and posed upon companies to cut the incidence of Valley Fever cases. Valley Fever has advance to cost companies thousands of dollars and is becoming every day more of an effort.

Conclusion

After studying the stakeholders interested in Valley Fever, it is easy to peep accepted themes between them. There is no doubt that while not known as a perilous disease, Valley Fever has the potential to be one. With the number of cases increasing each year and relatively minute research being done for prevention and cures, Valley Fever has earned the title as an emerging epidemic. While Coccidioides immitis only lives in a few hold areas of the United States, it poses a threat to people throughout the country due to the increasing popularity of visiting and absorbing to endemic areas. It also must not be forgotten that Valley Fever has the capability to affect animals as well humans increasing the cost of the disease for these species. It is clear that because of this, action must be taken in order to slash the number of cases and to decrease the severity of the cases.

This case search for points to a few relatively easy steps to capture in order to decrease the severity of Valley Fever cases. The most indispensable and most positive step is early detection. It was shown that the earlier that the disease is diagnosed, the less severe the symptoms and the less impact it has on the infected individual. Despite this easy solution, doctors saw their patients and average of three times before they tested for Valley Fever and the patients on average waited 44 days before treatment. These statistics point to a general lack of awareness this disease in both the patient and the medical world. In order to promote early detection, there must be better instruction of symptoms and complications keen in prolonged disease available to both the medical community and the population of endemic areas. This in theory would construct an awareness of the disease and aid earlier testing for it.

There are a few steps that can be taken in order to slice the number of cases of Valley Fever. As well as promoting early detection, public awareness of the disease could also befriend prick the number of cases. Public awareness of Valley Fever would carve the number of cases by providing the people with knowledge of its causes and ways to avoid exposure to the Coccidioides immitis spores. The second step that should be taken is a national focus on research in vaccines and cures for this disease. From this case gaze it is clear that contracting this disease could potentially be very costly. The financial burden will then be on either the infected individual themselves or on the position in some circumstances. These high costs are unacceptable when relatively petite investment is being made in the research of a cure or vaccination.

When considering these recommendations, it is vital to review the facts about this disease. Valley Fever is caused by the spores of a fungus that can become airborne when soil is unnerved. This fungus is endemic to ample portions of the American southwest including Phoenix, Arizona, the nation’s fifth largest city. Statistically, anyone living in endemic areas is likely to acquire this disease at least once in their lifetime. On top of those living in endemic areas, those visiting the plot have a high chance of contracting the disease. The number of cases has risen consistently each year for at least the last seven years. After reviewing these facts it is clear that Valley Fever has had a indispensable impact on our society and that steps need to be taken to slit its prevalence.

References

Introduction

(1) Chuang, Amy. “Disseminated Coccidioidomycosis in an Immunocompetent Person Living in Unique York City”. Journal of Urban Health: Bulletin of the Modern York Academy of Medicine, Vol. 82, No. 2, doi:10.1093/jurban/jti057

(2) Comrie, Andrew C. “Climate factors influencing coccidioidomycosis seasonality and outbreaks. Environmental Health Perspectives. June 2005 http://findarticles.com/p/articles/mi_m0CYP/is_/ai_n14816419

(3) DiSalvo, Dr. Arthur. Mycology – Chapter Six Dimorphic Fungi. 21 Nov. 2008 http://pathmicro.med.sc.edu/mycology/mycology-6.htm

(4) McKinley, Jesse. “Valley Fever hits epidemic numbers from Texas to Northern California”. Current York Times. 30 Dec. 2007 http://www.sfgate.com/cgi bin/article.cgi? f=/c/a/2007/12/30/MN12U6OGF.DTL&feed=rss.news

(5) Smith, Scott. “MedlinePlus Medical Encyclopedia: Coccidioidomycosis.” National Library of Medicine – National Institutes of Health. 9 Oct. 2006. 22 Nov. 2008 .

Medical Industry

(1) “Coccidioidomycosis..” NGC – National Guideline Clearinghouse . 1 Nov. 2005. 2 Nov. 2008
(2) Smith, Scott. “MedlinePlus Medical Encyclopedia: Coccidioidomycosis.” National Library of Medicine – National Institutes of Health. 9 Oct. 2006. 22 Nov. 2008 .

(3) “Valley Fever – Valley Fever Connections.” Valley Fever – Valley Fever Connections. 22 Nov. 2008 .

(4) “Valley fever – MayoClinic.com.” Mayo Clinic medical information and tools for healthy living – MayoClinic.com. 15 Mar. 2008. 22 Nov. 2008 .

(5) Interview Roni Cummings, Quality risk management: Notes in hand

Infected Individuals & Insurance Companies

(1) Arizona Department of Health Services. (2008). Valley Fever Annual Picture 2007 (1^st ed.). Phoenix, AZ: Arizona Department of Health Services, Division of Public Health Services.

(2) Interview with Anonymous Patient #1: Patient “V”. (Personal Communication, November 15, 2008).

(3) Interview with Anonymous Patient #2: Patient “F”. (Personal Communication, November 17, 2008).

(4) The Associated Press (2007, January 11). Ariz. Valley Fever Cases Soared in 2006. The Washington Post. All Pages.

(5) Unknown Author. (2008, October 29). Arizona Company Seeks Valley Fever Cure. BIO5 Institute News Archives. All Pages.

(6) Arizona Department of Health Services Webmaster. (2008, November 3). Infectious Disease Epidemiology. Retrieved November 15, 2008, from http://azdhs.gov/phs/oids/epi/disease /cocci/index.htm

(7) Author Unknown. (Last modified October 30, 2008). How Pre-Existing Conditions Work. Retrieved November 15, 2008, from http://health.howstuffworks.com/pre-existing-condition.htm

(8) BIO5 Institute at the University of Arizona. (2008). BIO5 Institute Home Page. Retrieved November 15, 2008, from http://bio5.arizona.edu/index.php

(9) Pfizer Inc. (Unknown Date). Pfizer Products. Retrieved November 15, 2008, from http://www.pfizer.com/products/rx/rx_product_diflucan.jsp

(10) Roerig, Division of Pfizer. (Last revised March 2008). Diflucan (LAB-0099-10.0). Retrieved November 15, 2008, from http://media.pfizer.com/files/products/uspi_diflucan.pdf

(11) The Mayo Clinic. (2006, March 17). Diseases and Conditions Valley Fever. CNN.com & MayoClinic.com. Retrieved from http://azdhs.gov/phs/oids/epi/disease/cocci/index.htm

(12) The University of Arizona. (Video Production). (2008, March 8). Innovation Day at UA 2008, UA @ the Leading Edge [Episode 1]. Development of the Valley Fever Vaccine. Video retrieved from http://www.youtube.com/watch? v=kgT0hFo49G4

(13) Valley Fever Center for Excellence at the University of Arizona. (2003). Valley Fever Center for Excellence: Coccidioidomycosis. Retrieved November 15, 2008, from http://www.vfce.ar izona.edu/

Infected Animals

(1) Mitchell, Chris. Blastomycosis, Cryptococcosis, Coccidioidomycosis (Valley Fever), Histoplasmosis, Disease and more. Animal Shelter Org. 2004. November 4, 2008.

(2) Valley Fever (Coccidiodomycosis). Mar Vista Animal Medical Center. 2006. November 5, 2008. http://www.marvistavet.com/index.html

(3) Valley Fever in Dogs. Valley Fever Center for Excellence. 2008. October 18, 2008.

Construction

(1) “Valley Fever” 1998-2008 Mayo Foundation for Medical Education and Research. Outbreak grips Arizona. March 17, 2006

(2) Benjamin J. Park, Keith Sigel, Victorio Vaz, Ken Komatsu, Cheryl McRill, Maureen Phelan, Timothy Colman, Andrew C. Comrie, David W. Warnock, John N. Galgiani, and Rana A. Hajjeh. “An Epidemic of Coccidioidomycosis in Arizona”, 1998-2001. The Journal of Infectious Diseases, 2005. 1 June.

(3) U.S Environmental Protection Agency. The super air act amendments of 1990. Clean Air Act. November 10th, 2008.

(4) MAG 2007 Five Percent Belief For PM-10 For The Maricopa County Nonattainment Residence. December 2007. Maricopa Association of Governments. < (www.mag.maricopa.gov)>

(5) Maricopa Air Quality Department. (2008). Dust Control. [Brochure]. Dust Compliance Resources Maricopa County.

(6) Maricopa County Air Pollution Control Regulations, Regulation III-Control of Air Contaminants Rule 310.

(7) Toribio, Jeovanny. “Maricopa County and dust regulations‏.” E-mail to Erin Dunsey. Oct. 21, 2008.

(1) Jason Jones, Turner Construction Inc, Oral interview, Done 10-21-2008

Notes in Authors hand

(2) Maricopa County Air Quality Department. “Air Quality Violators pay over $452K in October”. November 3, 2008. News.