Farm impacts of the 2019 Missouri River floods and economic valuation of flood risk reduction.

The 2019 Missouri River flood caused billions of dollars in damage to businesses, homes, and public infrastructure. Yet little is known about the farm-level effects of this event and farmers' perceptions of its causes. This study reports on the operational and financial setbacks farmers sustained because of the 2019 floods, as well as on their beliefs on the causes of these floods. It further explores farmers' willingness to pay (WTP) to avoid flood risks and the factors that condition it. The empirical application focuses on a sample of approximately 700 Missouri farmers operating near the Missouri River. Results show that yield loss, loss of growing crops, and inability to plant crops were the three most important consequences of flooding. Nearly 40% of the flood-affected farmers reported financial losses of $100,000 or more. Most respondents identified government decision makers as the cause of the 2019 floods, and many believe that government should prioritize flood control over other benefits (recreation and fish and wildlife habitat) the Missouri River system provides. The WTP results show that less than half of the surveyed farmers were willing to pay to avoid flood risks, with an average WTP estimated at $3 per $10,000 value of agricultural land. Subjective but not objective risk exposure influences WTP for flood risk reduction. Other important determinants of WTP are risk aversion, disutility from flood risks, and respondents' age, income, and education. Directions for policy to improve flood risk management in the Missouri River Basin are discussed.

Women's empowerment in agriculture and productivity change: The case of Bangladesh rice farms.

Using productivity change as a measure of farm economic performance, we analyze the relationship between women's empowerment in agriculture and farm productivity change and its components, which include efficiency change, technological change, and scale efficiency change. A non-parametric Malmquist approach is used to measure farm specific productivity change and its decomposition. We use a bootstrap regression to analyze factors that cause differences in productivity change and its components, testing, in particular, the role women's empowerment plays. The empirical application focuses on a sample of Bangladesh rice farms over the crop cultivation period 2011 and 2014. Results suggest that improvements in women's empowerment in agriculture were associated with higher levels of productivity change, efficiency change, and technical change, while they had no impact on scale efficiency change. We find that empowering women, specifically, improving their ability to make independent choices regarding agricultural production had a statistically significant positive association with productivity change, efficiency change, and technical change. We also find that lowering the gender parity gap is positively related with improving productivity of the sample farms.

Cervicofacial and mediastinal emphysema after balloon eustachian tuboplasty (BET): a retrospective multicenter analysis.

PURPOSE: Balloon Eustachian tuboplasty (BET) is a new treatment modality addressing chronic obstructive dysfunction of the Eustachian tube (ET). So far, BET has been deemed a safe procedure under general anesthesia with only minor adverse effects. However, individual cases of postoperative emphysema have been reported. In the present retrospective multicenter analysis we determined the incidence rate of this potentially life threatening complication after BET. METHODS: In total we collected data from 3,670 BET procedures performed on 2,272 patients in four tertiary care ENT departments. RESULTS: Ten cases of postoperative cervicofacial emphysema were documented, whereas only in 3 of them a pneumomediastinum was developed. None of the affected patients developed at any time serious clinical signs or symptoms besides cutaneous crepitations. A complete resolution and recovery of the emphysema occurred in all patients under antibiotic prophylaxis and abstinence from Valsalva maneuver within the first 2-6 postoperative days. CONCLUSIONS: Possible causes for the development of these postinterventional emphysemas are considered to be mucosal injuries of the ET during manipulations for the correct position of the insertion instrument, through a "kinking" of the balloon catheter or even due to the relative rigid catheter itself, although its form is regarded to be atraumatic. The complication rate of postoperative emphysema was 0.27% (95% CI 0.13-0.50%). The above facts in addition to only minor and transient overall complications after BET reported in literature, can label this procedure as a safe treatment with a low risk profile.

Medical and surgical treatment in divers with chronic rhinosinusitis and paranasal sinus barotrauma.

Aim of the study is to evaluate the effects of medical and surgical treatment in divers with paranasal sinus barotrauma (PSB) secondary to chronic rhinosinusitis (CRS). In this retrospective, cross-sectional, descriptive study 40 adult divers with CRS were included. Treatment of divers implied a 5-day course of a systemic steroid and a 6-week course of saline nasal irrigations and topical nasal steroid with mometasone in maximal dosage. If symptoms persisted, functional endoscopic sinus surgery (FESS) was performed. Questionnaires included the Sinonasal Outcome Test-20 German Adapted Version (SNOT-20 GAV), dive-related questions (DRQ) and general questions. Questionnaires were completed retrospectively by recalling the symptoms before and after therapy. Forty of 82 divers completed the questionnaires. Mean follow-up was 42 months (range 13-95 months). There was a statistically significant improvement of the Total score (TS) and of every subscore, except the General Quality of Life score, in the SNOT-20 GAV as well as of the TS in the DRQ. Before treatment, divers who required surgery reported significantly more symptoms than divers who were treated conservatively. Post treatment there were no significant differences between the medical and surgical group. Overall, 35 divers could resume diving after therapy even though PSB still occurred but without complications. Divers with sinus problems can successfully be managed medically and if conservative treatment fails, FESS shows a statistically significant improvement of symptoms and no serious long-term hazards for diving.

Suitability of the partially implantable active middle-ear amplifier Vibrant Soundbridge® to hyperbaric exposure.

INTRODUCTION: Active middle ear amplifiers represent a modern possibility to treat sensorineural, conductive and combined hearing loss. They can be in use in divers and patients who need hyperbaric oxygen therapy. Therefore, active middle-ear amplifiers have to be tested to determine whether or not they are prone to implosion or function loss in hyperbaric conditions. MATERIAL AND METHODS: We asked three of the companies registered by the German health authorities as manufacturers of active middle ear amplifiers to test their devices in hyperbaric conditions. Med-El agreed to support the study; Envoy stated that their devices were unable to withstand a pressure of 608 kPa; Otologics had no capacity to take part in this study. Twelve Vibrant Soundbridge® (Med-El) middle-ear amplifiers were tested in a water bath in a hyperbaric chamber. Four devices were pressurised to a maximum of 284 kPa, four devices to 405 kPa and four devices to 608 kPa, each for a maximum dive time of 78 minutes. RESULTS: The functions of the 12 devices were tested by the manufacturer pre- and post-hyperbaric exposure. Visual inspections as well as laboratory function tests were normal in all 12 devices after hyperbaric exposure. DISCUSSION AND CONCLUSION: Hyperbaric exposure to more than one bar pressure difference can result in structure damage, implosion or loss of function of the mechanical device. The Vibrant Soundbridge® middle-ear amplifier tolerated a single hyperbaric exposure to pressures of up to 608 kPa for 78 minutes with no loss of performance.