Trying to earn private health insurance can be a very astronomical hassle. If you’re not eligible for it through your employer or are not eligible to be listed as a dependent on someone else’s understanding, it can also be very expensive. However, there are some ways to ensure that you’re getting the maximum amount of benefits for the least amount of money.

The first step is to research what insurance companies offer individual health insurance plans in your residence. All states will have different insurance companies and different requirements. A tiny web research can go a long procedure here. For example, if you lived in South Carolina, you could type “South Carolina health insurance” into a search engine and regain a snappily overview of which companies offer plans in the space.

Next, you’ll need some quotes. There a few different ways to do this. Some companies do not provide online quotes, and you must call them or send them your information so that they can contact you by phone or mail. Many companies do provide online quotes, however, and this can be a expansive serve in your search.

One scheme to score quotes online is to go to each company’s website and occupy out a quote put a question to. You will have to provide some personal information, such as your name, gender, and date of birth. Some companies will also want to know your height, weight, and whether you are a tobacco user or have any pre-existing conditions. Form distinct you acknowledge the questions truthfully, because if you submit fallacious information for a quote it may invalidate your insurance later.

When you do this, the company will indicate real-time quotes for you moral on the website. Many companies also offer you the option to hold your insurance online. The quote should include the name of the conception, the type of understanding (HMO, PPO, Network, etc.), what benefits are covered, and what the monetary limits are. If you need attend, you can always call the company in put a question to.

Another, and probably a better, scheme to pick up quotes is to consume a website such as eHealthInsurance or Go Health Insurance. Websites like these allow you to type in your information and provide you with quotes from numerous companies all at once. These sites are very useful because they provide multiple notion quotes from multiple companies, all laid out side by side so you can easily and fast compare benefits and costs. Their navigation can sometimes be confusing, but the convenience of such sites is a worthwhile tradeoff for this. When you utilize these sites, and earn a view you want to seize, they also provide the link for you to purchase them directly from the company in expect.

Health insurance is a necessity in today’s society, and obtaining it can be relatively simple by using the power of the web.

Trying to pick up private health insurance can be a very gargantuan hassle. If you’re not eligible for it through your employer or are not eligible to be listed as a dependent on someone else’s belief, it can also be very expensive. However, there are some ways to ensure that you’re getting the maximum amount of benefits for the least amount of money.

The first step is to research what insurance companies offer individual health insurance plans in your region. All states will have different insurance companies and different requirements. A runt web research can go a long contrivance here. For example, if you lived in South Carolina, you could type “South Carolina health insurance” into a search engine and find a mercurial overview of which companies offer plans in the situation.

Next, you’ll need some quotes. There a few different ways to do this. Some companies do not provide online quotes, and you must call them or send them your information so that they can contact you by phone or mail. Many companies do provide online quotes, however, and this can be a spacious relieve in your search.

One diagram to pick up quotes online is to go to each company’s website and gain out a quote ask. You will have to provide some personal information, such as your name, gender, and date of birth. Some companies will also want to know your height, weight, and whether you are a tobacco user or have any pre-existing conditions. Design clear you acknowledge the questions truthfully, because if you submit spurious information for a quote it may invalidate your insurance later.

When you do this, the company will exhibit real-time quotes for you upright on the website. Many companies also offer you the option to grasp your insurance online. The quote should include the name of the conception, the type of conception (HMO, PPO, Network, etc.), what benefits are covered, and what the monetary limits are. If you need benefit, you can always call the company in interrogate.

Another, and probably a better, contrivance to obtain quotes is to expend a website such as eHealthInsurance or Go Health Insurance. Websites like these allow you to type in your information and provide you with quotes from numerous companies all at once. These sites are very useful because they provide multiple understanding quotes from multiple companies, all laid out side by side so you can easily and snappy compare benefits and costs. Their navigation can sometimes be confusing, but the convenience of such sites is a worthwhile tradeoff for this. When you exhaust these sites, and derive a thought you want to select, they also provide the link for you to pick them directly from the company in put a question to.

Health insurance is a necessity in today’s society, and obtaining it can be relatively simple by using the power of the web.

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

To attract and hold the best employees in a competitive job market
Survey after glimpse 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 encourage you keep your best workers.

To earn affordable health insurance coverage for yourself
If you have or are shopping for insurance for yourself and your family, you will regain that an individual health insurance thought is likely more expensive than a group health notion. The more employees you have, the lower the rates you can collect.

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 opinion is offered as a total compensation package, you may also chop 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 occupy 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 succor from lower premiums, but any earnings made on the Health Savings Narrative will also earn tax free.

To increase productivity and lower absenteeism
Research has shown that people who have health insurance are far more likely to purchase preventative health care measures than those without insurance. This makes them less likely to topple 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 – elated healthy employees are more likely to display 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 kindly for your business and employees. For ways to put on your Miniature Business Group Health Insurance, buy a search for 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 diminutive business may force you to pass on more of the costs to your employees, or to cessation offering health benefits altogether. Before you fabricate your decision, contemplate these five vital reasons why offering your employees Group Health Insurance may be money well-spent:

To attract and withhold the best employees in a competitive job market
Survey after search for 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 succor you support your best workers.

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

To assume advantage of available tax incentives for your business
There are a number of primary 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 conception is offered as a total compensation package, you may also slit 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 occupy 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 Opinion, not only will your employees succor from lower premiums, but any earnings made on the Health Savings Record will also score tax free.

To increase productivity and lower absenteeism
Research has shown that people who have health insurance are far more likely to choose preventative health care measures than those without insurance. This makes them less likely to topple 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 – cheerful healthy employees are more likely to expose 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 valid for your business and employees. For ways to set on your Little Business Group Health Insurance, grasp a explore at this article: Top 5 Tips For Saving Money on Diminutive Business Group Health Insurance.

Valley Fever is the current 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, Modern 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 belief that they had contracted it. The other forty percent come by symptoms ranging from serene to severe, including death. This emerging disease has had a astronomical accomplish on the human and animal populations in the endemic areas.

When soil containing these fungal spores is scared 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 fresh years, cases in prisoners at a California Central Valley correctional have reached as high as 1 inmate in every 10 tested (4).

The notable 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 bag unexcited to severe symptoms. The disease can manifest in three different types of forms; acute, chronic, or disseminated. Each originate ranges from minor to severe consequences. Most critical of all, is to know what the symptoms of Valley Fever are. There are ways to state 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 state. Those symptoms appear any where from 10-30 days after exposure to the spores. After one or two weeks some people will launch to originate painful rashes and or lumps on the lower situation of the legs. Symptoms that can be linked with the disease once contacted include joint swelling, joint distress, arthritis, ankle, feet, leg swelling. All of theses symptoms may not accrue in everyone and can vary from collected in some people to severe in others. Showing more then one of these symptoms should be a righteous 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 gain that Valley Fever takes, the severity of the effects on the body and how unsafe it can be will vary. The acute produce is rare and about 3% of the people that live in places with coccidiomycosis found in the dirt, will prove 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 build is rarer and less popular then the acute compose. It is more unsafe than the acute beget and can cause more problems. The chronic beget can become evident and design 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 originate lung abscesses. These abscesses can pop and erupt, releasing pus into the lungs. This pus then travels to the pleural situation or the spot between the lungs and the ribs. This can cause serious afflict 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 execute is the most perilous 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 net meningitis. This gain can be very deadly as it can cause swelling around the brain and spinal cord. With this beget, healthcare providers often peep ulcers and skin lesions, painful lesions in the skull and spine or bones, and painful, swollen joints. This is a life threatening construct and can cause death if not treated correctly. It can cause brain pain as well and can affect the brain/mental area of the person.

Everyone in the world is different and so not every person is going to be infected the same arrangement. People of different color or accelerate can contract the disease more readily then others of another hasten 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 accept 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 honest after their babies are born, are at an increased risk of getting Valley Fever. All of these factors will design it easy for them to bag the disease because their bodies can’t resist the initial infection. As well as with the lower immunity’s the body can’t fight attend as well causing them to find worse quicker and will be more severe. Age is a grand 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 frail immune systems are at higher risk for complications which may lead to the disseminated develop. It lets the disease spread easier through out the body and lets it collect into the considerable systems of the body. This can compose 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 current 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 construct it takes it can definite up from there or release pus. This pus then can collect absorbed into the body and stick to different types of organs. It can especially target places where it can earn up in such as joints, feet, and legs. This is because the fungi pick up into the blood stream which will net 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 ruin 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 accumulate 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 well-kept 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 gain 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 choose if there is a Valley Fever infection. Different medical professions expend 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 area where disease is growing will demonstrate up usually come 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 observe if the person is infected with the fungus and since it is more sensitive it can purchase 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 examine at the arm or the state 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 status will become red and swollen. Although this test is not being primitive as noteworthy anymore because it is not as specific, it however is frail in researching to understand the disease. A more favorite 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 search for if Valley Fever is reveal. The doctor my tap on the chest or have the person inhale steam-like mist to encourage cough up the sputum in order to come by 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 reveal 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 watch 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 exercise in determining more accurately if the disease is expose in the body. This is the only plan to be 100% clear 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. Well-liked 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 bewitch care of the disease. If the dilemma persists or if there is a higher possibility of complications and it is in its more severe produce, antifungal medications would be required to be taken. These medications would include amphotericin B, ketoconazole, fluconazole, or itraconazole. In a chronic produce or more acute design that won’t go away, amphotericin B is usually the medication given to abet fight off the disease. Then the person is monitored as to earn definite the condition does not worsen which might last from a couple months to a year. Surgical action may be an option to assume care of lesions that are localized. For the disseminated acquire fluconazole or itraconzole is commonly archaic. 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 stale as an alternate in this station if lesions are getting worse more swiftly and is weak to diffuse pneumonia. Surgery is indispensable in this case and in most reports at this stage it is important. This is extinct to assume care of grand abscesses, destructive lesions or bony sequestrations instability of the spine or the movement on distinguished organs such as the heart or tissues such as the spine. Since this fabricate 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 create it go away for apt as relapses can occur or the person can salvage 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 choose the longevity and affects of the person. The short affects include flu like symptoms and will go away. It is an annoyance fair 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 inaugurate 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 conclude 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 near abet. If not treated, the non-acute develop will worsen over time and in most cases accumulate into other organs of the body and effect the disseminated type. Taking care of the infection early on would be a generous strategy as Valley Fever can cause death if not treated at the upright time. If the disease is prolonged it can cause other diseases or illnesses. These include forming pneumonia and meningitis which originate the condition that considerable more deadly and difficult to treat. As both of those diseases are fatal as well and can compose poor 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 set the person at grievous 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 awful 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 design such as short of breath to something more perilous as not getting any air in and conclude 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 uncertain forms in the body. Many problems and complications would have to happen in order for it to net 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 reveal symptoms and require miniature to major treatment. This disease changes over longer periods of time. A person may have some time to go gape a doctor before they feel the severity of the disease. Though, as stated earlier, waiting for long periods of time to view medical care would not be trustworthy 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 halt with them for years at a time or even there entire life. This is something that if in interrogate consulting a doctor would be the best course of action so treatment can open 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 whisper of Valley Fever. Arguably, the role of infected persons or those that fill a new 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 share of the Southwestern United States where soils bear the Valley Fever fungus, will contract the disease at some point. Only a runt 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 principal to glimpse 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 state because there exist many factors that affect the lifestyles of those individuals, their families and their friends. In an anxiety to better assist this claim, the lives of two patients that contracted a serious invent of the infection, will be addressed and analyzed in the following paragraphs.

Before introducing specific cases, it is famous to review some novel facts and figures with regards to the disease. The Arizona Department of Health Services released their annual Valley Fever Recount 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 issue the research information in a thorough and comprehensive device 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 space. Although many people mediate of this disease as a unexcited illness similar to the well-liked frigid, Valley Fever is a key suppose 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 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 accomplish 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 residence 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 explain. Examining the personal accounts of two anonymous patients afflicted with a serious construct 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 gain complete anonymity.

The first case will put a question to the substandard 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 necessary 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 objective a chilly or some minute 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 jam, 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 itsy-bitsy, dismal situation on his left lung. The region indicated a relatively little, but famous 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 harm 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 section of his left lung was, indeed, Coccidioidomycosis. Another surgery to completely lift this fragment 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 distress 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 wound 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 invent 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 remove 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 vulgar joint discomfort. The build 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 mammoth, round nodule was located somewhere on her left lung. The patient was admitted to the hospital in 1998 and underwent a wedge resection, to seize the infected share (removed in wedge accomplish) of the lung. After the first surgery, Patient “F” was prescribed anti-fungal medication similar to Diflucan at elephantine strength for six elephantine 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 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 petite out-of-pocket costs through United American. However, she was aloof stupefied to stare 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. Unbiased for room and board and a shrimp 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 whine of Valley Fever. “Educate physicians on the east waft and west hover, 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 situation of consume. It is valuable to peep medical insurance companies as a stakeholder with regards to the explain 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 Bad 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 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 acquire fleshy 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 grunt bankruptcy if that happened…” Patient “V” explained. “I live in dismay because I know that if I were to accumulate 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 see). 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 site 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 Unusual York based foundation. They are currently testing an anti-fungal called Nikkomycin Z, which was first old to prevent fungal degradation in effect. 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 encourage fund pharmacology studies that will benefit effect 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 say 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 tumble significantly. Debates between the government, politicians and special interest groups would decrease as well if no one were in any steady 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 accept because of the availability to a cure, and possibly insurance that covers that cure. Major medical insurance companies like Aetna, Blue Detestable Blue Shield, Cigna and Humana will more freely distribute chubby coverage in instances of Valley Fever. Like most vaccinations and cures to accepted infections or diseases, there would be many sure outcomes to releasing this drug into the medical market, pending the completion of all drug safety trials.

As notable stakeholders with regards to the snarl 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 agreeable with regards to a feasible solution to the Coccidioidomycosis fungus, it is imperative that all people bag a intention to acquire health insurance coverage to some capacity. It is also necessary that individuals with preexisting conditions that aren’t on group medical plans lobby for their rights to complete insurance coverage. In considering the sinister effects of Valley Fever, there are many people who judge this topic is unbiased as critical 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 objective as likely to salvage Valley Fever as humans are. Animals obtain Valley Fever in the same design 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 gain sick. Some of the most accepted 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 status where there should normally be dim patterns. The white spots prove that the dog might have cancer in its lungs. The dog is only four years broken-down, 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 hastily as it has in this golden retriever. The owner had said fair two weeks prior to going to the vet that the dog was stout of energy on their vacation. The veterinarian doesn’t all the facts add up for the dog to have cancer so she decided to race 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 hastily. The dog starts to cough, has a loss of appetite, and microscopic 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 obvious that it must be a fungal disease and it was unprejudiced that, it was Valley Fever (1).

Dogs are the largest infected and most commonly reported animals with Valley Fever. Dogs earn Valley Fever in the same arrangement 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 end 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 positive symptoms that become note. 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 leisurely as 3 weeks. The cough that dogs net 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 reach the heart and puts pressure on the dogs windpipe which as a result irritates it (3). After the cough is demonstrate 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 noteworthy worse. The symptoms that become explain are: swelling of the limbs, encourage and neck afflict, seizures, soft swelling under the skin that resembles abscesses, swollen lymph nodes, observe inflammation, and non-healing skin ulcerations (3). Not all symptoms are explain lawful away and it can steal several months before positive symptoms appear. It can be several months after a cough appears that other symptoms become show. 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 resolve if a dog has Valley Fever there are different test that can be done. Some of the most accepted test done to resolve 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 explain 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 befriend 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 rob 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 shrimp 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 indicate the same symptoms as dogs do but it less likely for a cat to secure Valley Fever than it is for a dog. Cats find Valley Fever about every 1 case compared to 50 cases in dogs (3). When cats salvage the fungus their symptoms are usually a small 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 procedure. The same treatment for dogs can be dilapidated to treat cats with Valley Fever (3).

Horses are another animal that have been found to rep 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 distinguished 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 acquire Valley Fever are: Monkeys, Apes, and other primates. These animals exhaust the same treatment process as dogs and cats but is usually consists of a lifetime treatment (3).

Valley Fever is a very serious exclaim 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 near in technology has allowed for veterinarians to be able to detect Valley Fever at a less come 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 valid 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 necessary factors that have contributed to such increases. The speedy clearing and building were a principal 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 beget 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 yell. 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 agreeable (3). This implies its commitment and dedication to monitoring and posing regulations for anything threatening the quality of the air. The EPA has region limits on how worthy 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 essential legislation is the Super Air Act which has been passed to enforce desirable air standards and improve human health. The Well-organized Air Act is an outline for what national, situation, and local authorities must follow in order to protect air quality. Under the Desirable Air Act, local and status 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 valuable to know Maricopa County has 24 air monitoring sites in the Valley. The position of Arizona, under the Arizona department of environmental quality has its fill air monitoring sites as well. If any of these monitors exceeds the federal health standard for a given pollutant, the EPA will bear Maricopa County accountable. According to the Environmental Protection Agency (EPA), Maricopa County failed to arrive attainment for particulate pollution and thus is under federal orders to crop particulate matter pollution. In an attempt to address the announce, Maricopa County, the Maricopa Association of Governments (MAG) and local cities and towns submitted a notion to the EPA to point to how the county plans to sever PM₁₀ emissions by five percent each year until satisfactory levels are reached. The Five Percent Thought outlined more than 50 commitments to slit 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 near 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 bear within qualified dust standards. As section of the compliance, Maricopa County has devised that all sites with stupefied 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 serve enforce gracious 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 belief to conduct activities any that will disturb a surface space equal to or greater than 0.1 acre. Complying with the construction permit requirements is often a vital and daunting task. Before applying for a permit, a opinion that outlines the measures that will prevent the creation of dust must be presented. This concept 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 blueprint being the first of many that have been imposed on construction companies, entitles that all workers or subcontractors on state understand their responsibility while on place (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 Opinion must maintain a written log recording the right application and execution of the control measures previously outlined and favorite by the Dust Control Opinion. 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 section of narrate keeping is the trackout conditions. This rule also requires that all work sites that are more than two acres and gain afraid surfaces must install a trackout control devise. These devises are tremendous 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 microscopic to 25 cumulative linear feet (6).

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

Construction companies are required by space and federal law to implement a diligent disaster 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 jam 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 definite by the severity of the violation committed. Several factors are obsolete to calculate the amount of a penalty. In case there has been an economic serve 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 level-headed (9). In the month of September, the amount of $471,613.30 was serene in violations all related in one design or another to air quality control. This is the pain construction company’s face for not correctly using effective measures to crop dust in the construction sites, therefore causing potential problems to reach residents and workplaces, eventually becoming a financial quandary due to fines.

There is no better scheme 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 tall construction company that has a corporate office in Tempe, AZ. With a inquire to tell 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 distinct unbiased how distinguished companies who are in the construction industry are affected by laws to befriend slit 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 effort for the county is dust control. As a result for the growing worry 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 employ 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 traditional to fill fugitive dust. If they ever do not comply with these regulations, fines initiate 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 wait on own 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 gash dust in the construction sites, tremendous fines will follow. This is yet another allege companies are dealing with. To the load even greater, these companies also deal with the economical place backs from following these regulations. For companies to cleave and comply with county regulation, thousands of dollars are being forcefully spent by such companies. The contributions construction companies do to Valley Fever is not underestimated. As a result, strict regulations are followed and posed upon companies to crop the incidence of Valley Fever cases. Valley Fever has arrive to cost companies thousands of dollars and is becoming every day more of an difficulty.

Conclusion

After studying the stakeholders alive to in Valley Fever, it is easy to inspect accepted themes between them. There is no doubt that while not known as a unsafe disease, Valley Fever has the potential to be one. With the number of cases increasing each year and relatively itsy-bitsy 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 purchase areas of the United States, it poses a threat to people throughout the country due to the increasing popularity of visiting and engaging 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 cleave the number of cases and to decrease the severity of the cases.

This case perceive points to a few relatively easy steps to catch in order to decrease the severity of Valley Fever cases. The most vital 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 fervent in prolonged disease available to both the medical community and the population of endemic areas. This in theory would produce an awareness of the disease and succor earlier testing for it.

There are a few steps that can be taken in order to crop the number of cases of Valley Fever. As well as promoting early detection, public awareness of the disease could also back slice the number of cases. Public awareness of Valley Fever would slash 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 stare it is positive that contracting this disease could potentially be very costly. The financial burden will then be on either the infected individual themselves or on the place in some circumstances. These high costs are unacceptable when relatively small investment is being made in the research of a cure or vaccination.

When considering these recommendations, it is principal to review the facts about this disease. Valley Fever is caused by the spores of a fungus that can become airborne when soil is apprehensive. This fungus is endemic to titanic portions of the American southwest including Phoenix, Arizona, the nation’s fifth largest city. Statistically, anyone living in endemic areas is likely to net 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 distinct that Valley Fever has had a distinguished impact on our society and that steps need to be taken to cleave its prevalence.

References

Introduction

(1) Chuang, Amy. “Disseminated Coccidioidomycosis in an Immunocompetent Person Living in Fresh York City”. Journal of Urban Health: Bulletin of the Unusual 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”. Unusual 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 Record 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 shipshape air act amendments of 1990. Clean Air Act. November 10th, 2008.

(4) MAG 2007 Five Percent Conception For PM-10 For The Maricopa County Nonattainment State. 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 current 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, Novel 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 notion that they had contracted it. The other forty percent earn symptoms ranging from smooth to severe, including death. This emerging disease has had a astronomical finish on the human and animal populations in the endemic areas.

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 original years, cases in prisoners at a California Central Valley correctional have reached as high as 1 inmate in every 10 tested (4).

The necessary 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 score serene to severe symptoms. The disease can manifest in three different types of forms; acute, chronic, or disseminated. Each create ranges from minor to severe consequences. Most indispensable of all, is to know what the symptoms of Valley Fever are. There are ways to express 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 dwelling. Those symptoms appear any where from 10-30 days after exposure to the spores. After one or two weeks some people will originate to fabricate painful rashes and or lumps on the lower position of the legs. Symptoms that can be linked with the disease once contacted include joint swelling, joint harm, arthritis, ankle, feet, leg swelling. All of theses symptoms may not accrue in everyone and can vary from tranquil in some people to severe in others. Showing more then one of these symptoms should be a estimable indicator that the person has contracted the disease and should consult a doctor.

Once a body is infected, Valley Fever will explain 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 risky it can be will vary. The acute effect is rare and about 3% of the people that live in places with coccidiomycosis found in the dirt, will prove 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 recede like the body has caught the flu. Chronic obtain is rarer and less popular then the acute develop. It is more risky than the acute design and can cause more problems. The chronic execute can become evident and make 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 build lung abscesses. These abscesses can pop and erupt, releasing pus into the lungs. This pus then travels to the pleural site or the set between the lungs and the ribs. This can cause serious harm to the lungs and the person will have a difficult time breathing. Other symptoms include rude grade fever, weight loss, and nodules in the lungs. The disseminated execute is the most hazardous 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 obtain also pick up meningitis. This acquire can be very deadly as it can cause swelling around the brain and spinal cord. With this fabricate, healthcare providers often witness ulcers and skin lesions, painful lesions in the skull and spine or bones, and painful, swollen joints. This is a life threatening acquire and can cause death if not treated correctly. It can cause brain wound as well and can affect the brain/mental space of the person.

Everyone in the world is different and so not every person is going to be infected the same contrivance. People of different color or speed can contract the disease more readily then others of another accelerate 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 score 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 legal after their babies are born, are at an increased risk of getting Valley Fever. All of these factors will do it easy for them to pick up the disease because their bodies can’t resist the initial infection. As well as with the lower immunity’s the body can’t fight encourage as well causing them to bag worse quicker and will be more severe. Age is a ample 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 veteran immune systems are at higher risk for complications which may lead to the disseminated execute. It lets the disease spread easier through out the body and lets it bag into the essential systems of the body. This can execute 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 original construction or gardening, allowing one to breathe it in. Once it gets into the lungs it sticks in the inner share of the lungs. There it will grow and multiply inside the lungs. Depending on what get it takes it can certain up from there or release pus. This pus then can rep absorbed into the body and stick to different types of organs. It can especially target places where it can fabricate up in such as joints, feet, and legs. This is because the fungi win into the blood stream which will derive 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 extinguish 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 bag 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 well-organized 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 manufacture 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 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 spot where disease is growing will present up usually reach 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 spy if the person is infected with the fungus and since it is more sensitive it can recall 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 honest a shrimp below the skin, preferably in the forearm similar to a TB (PPD) test. Then the doctor will seek at the arm or the region 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 traditional as considerable anymore because it is not as specific, it however is venerable in researching to understand the disease. A more approved 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 search for if Valley Fever is reveal. The doctor my tap on the chest or have the person inhale steam-like mist to abet cough up the sputum in order to procure 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 reveal 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 gape 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 indicate in the body. This is the only diagram to be 100% distinct 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. Popular 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 choose care of the disease. If the dilemma persists or if there is a higher possibility of complications and it is in its more severe make, antifungal medications would be required to be taken. These medications would include amphotericin B, ketoconazole, fluconazole, or itraconazole. In a chronic do 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 create positive the condition does not worsen which might last from a couple months to a year. Surgical action may be an option to bewitch care of lesions that are localized. For the disseminated build fluconazole or itraconzole is commonly dilapidated. 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 former as an alternate in this status if lesions are getting worse more snappy and is old to diffuse pneumonia. Surgery is significant in this case and in most reports at this stage it is well-known. This is dilapidated to grasp care of mountainous 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 execute 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 produce it go away for friendly as relapses can occur or the person can secure 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 resolve the longevity and affects of the person. The short affects include flu like symptoms and will go away. It is an annoyance impartial like any time someone gets sick and the person can go on with their life with no afflict. These people probably have higher immune systems. However, the longer the disease stays around in the body the more wound it will do. If it is prolonged in the body for an extended time it will initiate 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 approach wait on. If not treated, the non-acute earn will worsen over time and in most cases come by into other organs of the body and make the disseminated type. Taking care of the infection early on would be a kindly strategy as Valley Fever can cause death if not treated at the true time. If the disease is prolonged it can cause other diseases or illnesses. These include forming pneumonia and meningitis which develop the condition that great more deadly and difficult to treat. As both of those diseases are fatal as well and can compose abominable mixes with Valley Fever. Bleeding and lung abscesses could perform which have to be medically treated and in some cases have to be done with surgery. Prolonged exposure can attach the person at obscene 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 awful effects as the body can’t collect 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 earn such as short of breath to something more perilous as not getting any air in and discontinuance 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 unsafe forms in the body. Many problems and complications would have to happen in order for it to net 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 present symptoms and require itsy-bitsy to major treatment. This disease changes over longer periods of time. A person may have some time to go observe a doctor before they feel the severity of the disease. Though, as stated earlier, waiting for long periods of time to gaze medical care would not be proper 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 end with them for years at a time or even there entire life. This is something that if in inquire 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 important stakeholders that would be affected, at least in some capacity, if an executive decision were to be made with regards to the roar of Valley Fever. Arguably, the role of infected persons or those that have a current 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 stamp 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 fragment of the Southwestern United States where soils enjoy the Valley Fever fungus, will contract the disease at some point. Only a minute percentage of people, however, are diagnosed with a severe enough develop of the infection where medical treatment is needed. Anti-fungal medication is the most favorite 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 essential to notice individuals currently struggling with the disease as well as those who have recovered from a serious beget of Coccidioidomycosis as a stakeholder with regards to this grunt because there exist many factors that affect the lifestyles of those individuals, their families and their friends. In an exertion to better serve this claim, the lives of two patients that contracted a serious get of the infection, will be addressed and analyzed in the following paragraphs.

Before introducing specific cases, it is necessary to review some current facts and figures with regards to the disease. The Arizona Department of Health Services released their annual Valley Fever Record in October 2008. The recount, 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 speak the research information in a thorough and comprehensive contrivance 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 area. Although many people contemplate of this disease as a peaceful illness similar to the celebrated frigid, Valley Fever is a key bellow 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 allotment 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 manufacture of Coccidioidomycosis each year. The Arizona Department of Health Services reports that the severity of Valley Fever in the spot 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 enlighten. Examining the personal accounts of two anonymous patients afflicted with a serious get 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 fill complete anonymity.

The first case will interrogate the infamous 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 considerable 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 fair a chilly or some minute infection or something like that.” Soon after the initial stages of the disease, Patient “V” began experiencing constant, severe hurt in the left side of his chest. Although he made numerous medical appointments for this predicament, the wound would subside by the time Patient “V” arrived, making it difficult to diagnose the plight. “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 shrimp, black situation on his left lung. The set indicated a relatively dinky, but well-known 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 harm 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 fraction of his left lung was, indeed, Coccidioidomycosis. Another surgery to completely engage 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 afflict 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 injure 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 develop 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 celebrated drug distributed to sufferers of the infection. Patient “V” was required to assume 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 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 immense, round nodule was located somewhere on her left lung. The patient was admitted to the hospital in 1998 and underwent a wedge resection, to lift the infected section (removed in wedge acquire) of the lung. After the first surgery, Patient “F” was prescribed anti-fungal medication similar to Diflucan at stout strength for six elephantine 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 residence 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 miniature out-of-pocket costs through United American. However, she was unexcited worried to observe the total amount owed from her pause 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 fantastic. Fair for room and board and a slight 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 assert of Valley Fever. “Educate physicians on the east sail 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 region of remove. It is well-known to gape medical insurance companies as a stakeholder with regards to the impart 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 idea. 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 Execrable 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 recent understanding 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 corpulent 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 verbalize 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 tell bankruptcy if that happened…” Patient “V” explained. “I live in dread because I know that if I were to find 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 spy). 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 space 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 Modern York based foundation. They are currently testing an anti-fungal called Nikkomycin Z, which was first former to prevent fungal degradation in earn. 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 support 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 relate 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 valid 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 gather because of the availability to a cure, and possibly insurance that covers that cure. Major medical insurance companies like Aetna, Blue Faulty Blue Shield, Cigna and Humana will more freely distribute chubby coverage in instances of Valley Fever. Like most vaccinations and cures to accepted 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 critical stakeholders with regards to the boom 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 generous with regards to a feasible solution to the Coccidioidomycosis fungus, it is imperative that all people fetch a contrivance to acquire health insurance coverage to some capacity. It is also valuable that individuals with preexisting conditions that aren’t on group medical plans lobby for their rights to complete insurance coverage. In considering the evil effects of Valley Fever, there are many people who consider this topic is unprejudiced 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 win Valley Fever as humans are. Animals net Valley Fever in the same scheme 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 bag sick. Some of the most approved 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 space where there should normally be sad patterns. The white spots show that the dog might have cancer in its lungs. The dog is only four years veteran, 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 execute as like a flash as it has in this golden retriever. The owner had said fair two weeks prior to going to the vet that the dog was corpulent of energy on their vacation. The veterinarian doesn’t all the facts add up for the dog to have cancer so she decided to bustle 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 quick. 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 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 derive Valley Fever in the same scheme 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 retort and surround the infection to waste 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 raze 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 explain. 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 gradual as 3 weeks. The cough that dogs rep 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 indicate 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 grand worse. The symptoms that become expose are: swelling of the limbs, attend and neck injure, seizures, soft swelling under the skin that resembles abscesses, swollen lymph nodes, watch inflammation, and non-healing skin ulcerations (3). Not all symptoms are exhibit true away and it can pick several months before sure symptoms appear. It can be several months after a cough appears that other symptoms become note. 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 resolve if a dog has Valley Fever there are different test that can be done. Some of the most accepted test done to resolve 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 display 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 benefit 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 hold 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 small side effects. This is usually given to dogs that have hurt 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 indicate the same symptoms as dogs do but it less likely for a cat to fetch Valley Fever than it is for a dog. Cats secure Valley Fever about every 1 case compared to 50 cases in dogs (3). When cats secure the fungus their symptoms are usually a limited 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 archaic to treat cats with Valley Fever (3).

Horses are another animal that have been found to derive 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 novel though, and with medical technology improvement chance of survival with novel medicine is noteworthy 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 favorite animals to earn Valley Fever are: Monkeys, Apes, and other primates. These animals exercise the same treatment process as dogs and cats but is usually consists of a lifetime treatment (3).

Valley Fever is a very serious declare 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 arrive in technology has allowed for veterinarians to be able to detect Valley Fever at a less reach 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 valid 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 vital factors. Among those factors like dry climate, the unique building booms have been one of the most important factors that have contributed to such increases. The posthaste clearing and building were a principal 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 notable 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 compose jobs in the field of construction, ranching and agricultural work (1).

The decade following the 90’s has had a enormous 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 whisper. 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 slice 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 generous (3). This implies its commitment and dedication to monitoring and posing regulations for anything threatening the quality of the air. The EPA has position limits on how noteworthy pollution is allowed to be in the air. In its goal to have 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 critical legislation is the Trim Air Act which has been passed to enforce dapper air standards and improve human health. The Shapely Air Act is an outline for what national, region, and local authorities must follow in order to protect air quality. Under the Well-organized Air Act, local and site 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 valuable to know Maricopa County has 24 air monitoring sites in the Valley. The site of Arizona, under the Arizona department of environmental quality has its have air monitoring sites as well. If any of these monitors exceeds the federal health standard for a given pollutant, the EPA will maintain Maricopa County accountable. According to the Environmental Protection Agency (EPA), Maricopa County failed to near attainment for particulate pollution and thus is under federal orders to slice particulate matter pollution. In an attempt to address the assert, Maricopa County, the Maricopa Association of Governments (MAG) and local cities and towns submitted a concept to the EPA to explain how the county plans to slash PM₁₀ emissions by five percent each year until estimable levels are reached. The Five Percent Opinion 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 near 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 bear within gracious dust standards. As portion of the compliance, Maricopa County has devised that all sites with timid 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 back enforce beneficial 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 conception 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 principal and daunting task. Before applying for a permit, a concept 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 blueprint being the first of many that have been imposed on construction companies, entitles that all workers or subcontractors on place understand their responsibility while on residence (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 maintain a written log recording the trusty application and execution of the control measures previously outlined and favorite by the Dust Control View. 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 fraction of picture keeping is the trackout conditions. This rule also requires that all work sites that are more than two acres and hold insecure surfaces must install a trackout control devise. These devises are enormous 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 shrimp 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 location of interest is more than one acre a series of dust control training must recall area. All workers directly alive to in the containment of dust like the water truck drivers and water pull drivers must lift a basic dust control training class in which attendees will ultimately become certified if successfully completed the training class. An extension from this piece lists that a dust control coordinator must be note on job residence if the dimension of the job set is five acres and up (5). These onsite coordinators must have completed a comprehensive dust control training in which they are given trustworthy 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 location and federal law to implement a diligent worry 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 pickle 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 clear by the severity of the violation committed. Several factors are frail to calculate the amount of a penalty. In case there has been an economic encourage 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 unexcited (9). In the month of September, the amount of $471,613.30 was unexcited in violations all related in one method or another to air quality control. This is the grief construction company’s face for not correctly using effective measures to slash dust in the construction sites, therefore causing potential problems to come residents and workplaces, eventually becoming a financial spot 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 immense construction company that has a corporate office in Tempe, AZ. With a interrogate to roar 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 unprejudiced how distinguished companies who are in the construction industry are affected by laws to encourage prick 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 trouble 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 consume 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 old-fashioned to bear fugitive dust. If they ever do not comply with these regulations, fines initiate 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 plight 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 support fill 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, vast fines will follow. This is yet another divulge companies are dealing with. To the load even greater, these companies also deal with the economical site backs from following these regulations. For companies to cleave and comply with county regulation, thousands of dollars are being forcefully spent by such companies. The contributions construction companies beget to Valley Fever is not underestimated. As a result, strict regulations are followed and posed upon companies to prick the incidence of Valley Fever cases. Valley Fever has reach to cost companies thousands of dollars and is becoming every day more of an worry.

Conclusion

After studying the stakeholders enthusiastic in Valley Fever, it is easy to gawk approved themes between them. There is no doubt that while not known as a risky disease, Valley Fever has the potential to be one. With the number of cases increasing each year and relatively tiny 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 engage areas of the United States, it poses a threat to people throughout the country due to the increasing popularity of visiting and provocative 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 determined that because of this, action must be taken in order to gash the number of cases and to decrease the severity of the cases.

This case recognize points to a few relatively easy steps to purchase in order to decrease the severity of Valley Fever cases. The most essential and most distinct 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 enthusiastic in prolonged disease available to both the medical community and the population of endemic areas. This in theory would earn an awareness of the disease and abet earlier testing for it.

There are a few steps that can be taken in order to gash the number of cases of Valley Fever. As well as promoting early detection, public awareness of the disease could also attend nick the number of cases. Public awareness of Valley Fever would crop 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 sight 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 status in some circumstances. These high costs are unacceptable when relatively miniature investment is being made in the research of a cure or vaccination.

When considering these recommendations, it is essential to review the facts about this disease. Valley Fever is caused by the spores of a fungus that can become airborne when soil is terrified. This fungus is endemic to gargantuan 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 position 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 determined that Valley Fever has had a vital impact on our society and that steps need to be taken to nick its prevalence.

References

Introduction

(1) Chuang, Amy. “Disseminated Coccidioidomycosis in an Immunocompetent Person Living in Current York City”. Journal of Urban Health: Bulletin of the Fresh 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”. Unusual 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 Recount 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 Notion For PM-10 For The Maricopa County Nonattainment Spot. 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.