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For almost fifty years, coal dominated the Navajo economy. But in 2019 one of the Navajo Nation's largest coal plants closed. This comprehensive new work offers a deep dive into the complex inner workings of energy shift in the Navajo Nation. Geographer Andrew Curley, a member of the Navajo Nation, examines the history of coal development within the Navajo Nation, including why some Diné supported coal and the consequences of doing so. He explains the Navajo Nation's strategic choices to use the coal industry to support its sovereignty as a path forward in the face of ongoing colonialism. Carbon Sovereignty demonstrates the mechanism of capitalism through colonialism and the construction of resource sovereignty, in both the Navajo Nation's embrace and its rejection of a coal economy. For the people of the Navajo Nation, energy sovereignty is dire and personal. Thanks to on-the-ground interviews with Diné coal workers, environmental activists, and politicians, Curley documents the real consequences of change as they happened. While some Navajo actors have doubled down for coal, others have moved toward transition. Curley argues that political struggles ultimately shape how we should understand coal, capitalism, and climate change. The rise and fall of coal magnify the nuance and complexity of change. Historical and contemporary issues intermingle in everyday life with lasting consequences.

Indigenous peoples in the United States have faced continued land dispossession for centuries. Through the reservation system as well as policies including forced removal and allotment, colonial settlers and later the federal government acquired over two billion acres from Native Nations. We argue that another important, yet understudied and unquantified, contributor to tribal land loss is through the construction of dams. By restricting water flow in rivers or lakes, dams submerge land under reservoirs and disrupt aquatic and terrestrial ecosystems. This impacts livelihoods of local communities, destroys culturally important places and resources, and displaces people from their homes and land. To quantify the amount of tribal land lost as a result of dam construction, we engage in an innovative data linkage project. We use geospatial data on the boundaries of federal Indian reservations and Oklahoma Tribal Statistical Areas (OTSAs) and overlay these data with the locations of approximately 7,900 dams in the continental US. We estimate that 139 dams have submerged over 619 000 acres of land on 56 federal reservations and that 287 dams have inundated over 511 000 acres of land on 19 OTSAs. Taken together, our lower-bound estimate is that over 1.13 million acres of tribal land have been flooded under the reservoirs of 424 dams, which amounts to an area larger than Great Smokey Mountains National Park, Grand Teton National Park, and Rocky Mountain National Park combined. In light of recent federal legislation to address aging infrastructure in the US as well as the increasing risks to dam function and safety caused by climate change, dams that impact tribal land should be prioritized for removal. In cases where removal is not a preferred or viable option, alternatives include tribal ownership or funding for repairs and improvements.

Purpose To evaluate studies utilizing orthobiologics in the management of femoroacetabular impingement syndrome (FAIS) to (1) assess the indications for usage, and (2) analyze patient-reported outcome measures (PROM) following treatment. It was hypothesized that orthobiologics would (1) be utilized for symptomatic FAIS in the setting of labral or chondral pathology, and (2) improve PROM at most recent follow-up. Methods The Pubmed, Ovid Medline, Cochrane, and Web of Science databases were searched for clinical studies evaluating orthobiologics [hyaluronic acid (HA), platelet-rich plasma (PRP), or cell-based therapy (CBT) for treatment of FAIS. Exclusion criteria included orthobiologics used in conjunction with cartilage transfer or scaffolding procedures and a primary indication other than FAIS. Data collection included patient demographics, indications, and baseline and most recent PROM. Results Eleven studies (one level I, four level II, four level III, and two level IV evidence) met inclusion criteria, consisting of 440 patients with mean ages ranging from 32.8 to 47 years. All 11 studies demonstrated an improvement in PROM from baseline to most-recent follow-up. Four studies administered PRP either intraoperatively or the day after surgery as an adjunct to labral repair. CBT was used intraoperatively in the setting of acetabular chondral lesions (three studies) and labral repair (one study). When comparing to a control group at most recent follow-up, three PRP cohorts demonstrated similar PROM (n.s.), while one PRP group exhibited worse visual analog pain scores (2.5 vs. 3.4, p  = 0.005) and modified Harris Hip Scores (mHHS) (82.6 vs. 78.7, p  = 0.049). The four CBT studies reported favorable results compared to a control group, with a significantly higher mHHS at most recent follow-up or mean improvement from baseline in Hip Outcome Score–Activities of Daily Living ( p  < 0.05). Three studies reported on HA, which was utilized exclusively in the nonoperative setting. Conclusions Intraoperative PRP and CBT have been commonly reported in the setting of hip arthroscopy for labral repairs and acetabular chondral lesions, respectively. The CBT cohorts demonstrated more favorable PROM at most recent follow-up when compared to a control group, though these results should be interpreted with caution due to heterogeneity of orthobiologic preparations. Level of evidence IV.

The development of coal mining in the Navajo Nation, the largest Indian reservation in the United States, is understood as a consequence of economic dependency, resource curse, modernization, cultural contradiction, and so on. Missing from these frameworks are the perspectives of indigenous actors who participate in these industries. This article draws on ethnographic fieldwork and interviews conducted with Navajo coal workers and community members during a 2013 lease renewal to analyze how a moral economy of Navajo coal workers accounts for the mobilization of Navajo labor in support of the industry, despite years of exploitation and environmental damage. This article's central argument is that the moral economy of Navajo coal workers is built on a subsistence logic, summarized in the Navajo idiom t'áá hwó ají t'éego, which emphasizes notions of \"hard work\" on one's \"traditional\" land and is produced in the collective conditions of a worker's union. Even as the future of coal looks bleak, understanding how this folk ideology mobilizes Navajo workers in support of a declining industry gives us a better understanding of the integration of indigenous peoples into capitalist processes. Key Words: coal, indigenous geography, moral economy, Navajo, resource geography. 在纳瓦霍族国这个美国最大的印第安保留区中的煤矿开发, 被理解为经济依赖、资源诅咒、现代化、文化冲突等结果。这些认识架构所缺少的, 是参与在这些产业中的原住民族行动者的视角。本文运用2013年採矿权租约展延期间与纳瓦霍族矿工和族人所进行的民族志田野工作与访谈, 分析纳瓦霍矿工的道德经济, 如何解释尽管常年的剥削与环境伤害, 纳瓦霍工人仍动员支持该产业。本文的核心主张是, 纳瓦霍工人的道德经济, 建立在生计逻辑之上, 并以纳瓦霍的俗语\"T'áá hwó ají t'éego\"概括之, 强调在自身的\"传统\"土地上\"勤奋工作\"的概念, 并且在工人工会的集体条件下进行生产。尽管煤矿的未来相当严峻, 理解此般民间意识形态如何动员纳瓦霍工人以支持一个衰败的产业, 让我们对于原住民族整合进入资本主义有更佳的理解。关键词: 煤炭, 原住民族地理学, 道德经济, 纳瓦霍人, 资源地理学 。 El desarrollo de la minería del carbón en la Nación Navajo, la más grande de las reservaciones indias de los Estados Unidos, es vista como una consecuencia de la dependencia económica, la maldición del recurso, la modernización, la contradicción cultural y así sucesivamente. Lo que no aparece en estos esquemas son las perspectivas de los actores indígenas que participan en estas industrias. Este artículo se basa en trabajo de campo etnográfico y entrevistas administradas en 2013 a obreros navajo que trabajan el carbón y a miembros de la comunidad, al renovarse el arrendamiento, con el fin de analizar cómo una economía moral de aquellos trabajadores puede explicar la movilización laboral navajo en apoyo de la industria carbonífera, pese a años de explotación y daño ambiental. El argumento central del artículo es que la economía moral de los trabajadores navajo del carbón está construida alrededor de una lógica de subsistencia, resumida en la expresión navajo t'áá hwó ají t'éego, la cual enfatiza nociones de \"trabajo duro\" en nuestra tierra \"tradicional,\" y es producida en las condiciones colectivas del sindicato del trabajador. Aun si el futuro del carbón luce sombrío, entender cómo esta ideología popular moviliza a los trabajadores navajo en apoyo de una industria en declive nos facilita una mejor comprensión de la integración de los pueblos indígenas en los procesos capitalistas. Palabras clave: carbón, geografía indígena, economía moral, Navajo, geografía de los recursos.

Purpose To evaluate the literature on patients undergoing periacetabular osteotomy after failed hip arthroscopy (PAO-FHA) for (1) patient demographics and hip morphology, (2) changes in preoperative to postoperative patient-reported outcomes (PROs), and (3) PROs in comparison to primary periacetabular osteotomy (PAO) patients. Methods A systematic literature search of Pubmed, CINAHL/Medline, and cochrane databases was performed in accordance with PRISMA guidelines. The search phrase was “(periacetabular osteotomy or PAO or rotational osteotomy) and (hip arthroscopy or arthroscopic)”. The titles, abstracts, and full texts were screened for studies on PAO-FHA. Study quality was assessed, and relevant data were collected. A meta-analysis was not performed due to study heterogeneity. Results The search identified 7 studies, including 151 hips (148 patients, 93.9% female) undergoing PAO-FHA, out of an initial 593 studies, with three Level IV and four Level III studies. Mean time from hip arthroscopy to PAO ranged from 17.0 to 29.6 months. Heterogenous hip morphologies and radiologic findings prior to PAO were observed, though patients most frequently demonstrated moderate-to-severe dysplasia (mean or median lateral center edge angle < 20°) and minimal osteoarthritis (Tönnis grade 0 or 1). In all 5 studies that reported concomitant procedures with PAO, femoral and/or acetabular osteoplasty was performed via arthroscopy or arthrotomy. Following PAO-FHA, radiographic acetabular coverage and PROs improved in all 6 studies that reported postoperative outcomes. All four comparative studies of primary PAO vs. PAO-FHA included patients with mean or median LCEAs < 20°, reporting mixed outcomes for the optimal treatment approach. Conclusion PAO-FHA is reported in a heterogenous patient population that frequently includes hips with moderate-to-severe dysplasia and minimal osteoarthritis. Regardless of hip morphology or concomitant procedures, all studies that reported postoperative outcomes demonstrated improved PROs following PAO-FHA. Level of evidence Level IV.

Deep infection is a debilitating complication after shoulder arthroplasty. The authors hypothesized that an intra-articular, intraoperative injection of antibiotics would result in a lower infection rate compared with intravenous antibiotics alone. Before 2007, 164 patients (group A) did not receive intra-articular antibiotics. From 2007 to 2018, 1324 patients (group B) received intra-articular antibiotics. Patients received intra-articular gentamicin at the end of surgery with the addition of 1 g of cefazolin in January 2014. Records were retrospectively reviewed for comorbidities, type of surgery, and infection. The cohort that received intra-articular antibiotics was compared with the cohort that did not to determine the effect of prophylactic intra-articular antibiotic administration in preventing infection. There was 1 deep infection in the antibiotic group compared with 5 in the non-antibiotic group (P<.001). Superficial infections developed in 2 cases of patients treated with antibiotics; there were no superficial infections in patients treated without antibiotics (P=.62). One previous study evaluated intra-articular injection of antibiotics for shoulder arthroplasty and found significantly lower rates of infection with the injection of intra-articular gentamicin. In this retrospective follow-up study, the injection of intra-articular gentamicin or gentamicin and cefazolin effectively decreased rates of postoperative infection. At mean follow-up of 399 days, intra-articular antibiotics at the time of surgery resulted in significantly fewer deep infections. Given the minimal risk of adverse events and minimal cost, this is a valid method of reducing infections in total shoulder arthroplasty. [Orthopedics. 202x;4x(x):xx–xx.]

Negative pressure wound therapy (NPWT) has shown promise in reducing postoperative complications in several applications in orthopedic surgery, including trauma and arthroplasty. To the authors' knowledge, no study has evaluated its use in multiligament knee reconstruction. Multiligament knee reconstruction is often fraught with arthrofibrosis and wound-healing complications. This retrospective study assessed complications requiring reoperation in patients who underwent multiligament knee reconstruction and received either NPWT (n=14) or a dry sterile dressing (DSD) (n=44). There were significantly more reoperations in the cohort of patients who received a DSD (P=.011). Arthrofibrosis in particular showed a significantly lower rate of occurrence in the NPWT cohort compared with the DSD cohort (P=.025). There was a trend toward a lower infection rate in the NPWT cohort (P=.322). This study provides evidence that NPWT may be effective in reducing reoperation after multiligament knee reconstruction. Further investigations with prospective studies are needed to draw stronger conclusions about the benefits of NPWT. [Orthopedics. 2021;44(3):187–191.]

Blood flow restriction (BFR) therapy is being used more frequently for rehabilitation from orthopedic injuries. Several physiologic mechanisms of action, at local and systemic levels, have been proposed. Numerous studies have investigated the effects of BFR training in healthy athletes; however, limited clinical data exist supporting the use of BFR after surgery. Given that BFR training may facilitate muscle development using low-load resistance exercises, it offers a unique advantage for the post-surgical patient who cannot tolerate traditional high resistance training. [Orthopedics. 2021;44(6):e694–e698.]

Background: The statistical significance of a given study outcome can be liable to small changes in findings. P values are common, but imperfect statistical methods to convey significance, and inclusion of the fragility index (FI) and fragility quotient (FQ) may provide a clearer perception of statistical strength. Purpose/Hypothesis: The purpose was to examine the statistical stability of studies comparing primary single-bundle to double-bundle anterior cruciate ligament reconstruction (ACLR) utilizing autograft and independent tunnel drilling. It was hypothesized that the study findings would be vulnerable to a small number of outcome event reversals, often less than the number of patients lost to follow-up. Study Design: Systematic review; Level of evidence, 2. Methods: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, the authors searched PubMed for comparative studies and randomized controlled trials (RCTs) published in select journals, based on impact factor, between 2005 and 2020. Risk-of-bias assessment and methodology scoring were conducted for the included studies. A total of 48 dichotomous outcome measures were examined for possible event reversals. The FI for each outcome was determined by the number of event reversals necessary to alter significance. The FQ was calculated by dividing the FI by the respective sample size. Results: Of the 1794 studies screened, 15 comparative studies were included for analysis; 13 studies were RCTs. Overall, the mean FI and FQ were 3.14 (IQR, 2-4) and 0.050 (IQR, 0.032-0.062), respectively. For 72.9% of outcomes, the FI was less than the number of patients lost to follow-up. Conclusion: Studies comparing single-bundle versus double-bundle ACLR may not be as statistically stable as previously thought. Comparative studies and RCTs are at substantial risk for statistical fragility, with few event reversals required to alter significance. The reversal of fewer than 4 outcome events in a treatment group can alter the statistical significance of a given result; this is commonly less than the number of patients lost to follow-up. Future comparative study analyses might consider including FI and FQ with P values in their statistical analysis.

Background: Despite a growing body of literature regarding anterior cruciate ligament reconstruction (ACLR), there remains a wide diversity in surgical technique and clinical practice across providers. Purpose: To (1) describe current ACLR practice preferences among members of the Herodicus society and (2) determine whether these preferences are influenced by years in practice and overall surgical volume. Study Design: Cross-sectional study. Methods: A 24-question survey investigating surgeons’ practices and preferred ACLR surgical techniques was sent via email to all active Herodicus Society members. Survey responses were subdivided by years of experience and overall ACLR annual case volume. Descriptive statistics were compiled and chi-square testing was utilized to determine the significance of experience and case volume on survey responses. Results: Of the 113 invited Herodicus Society members who perform ACLR, 69 (61%) completed the survey. Respondents had a mean ± SD of 30.9 ± 9.8 years of experience in clinical practice and performed a mean of 96.0 ± 50.7 primary and 21.6 ± 16.9 revision ACLR annually. Of revision cases, 72.1% were performed using a single-stage technique. Mean frequency of graft usage by surgeon was bone–patellar tendon–bone autograft (58.6%), quadriceps autograft (14.6%), hamstring tendon autograft (14.0%), and allograft (11.8%). The plurality of surgeons responded that they used anterolateral augmentation “rarely” in primary ACLR (39.1%) and “sometimes” in revision ACLR (31.9%), with the majority performing lateral extra-articular tenodesis (66.7%) rather than anterolateral ligament reconstruction (14.5%). Most surgeons would not allow a 20-year-old football player to return before 7 months after ACLR (71.0%) but highly valued return-to-sports testing to determine readiness (94.2%). Higher volume surgeons performed single-stage revision ACLR at a significantly higher rate (79.8% vs 62.9%, P = .02) and significantly differed in return-to-sports criteria, with a greater proportion relying primarily on biometric testing (P = .01). Conclusion: The survey demonstrated that, in the Herodicus Society, a wide range of preferences exist regarding ACLR surgical technique. Bone–patellar tendon–bone autograft is the most frequent primary ACLR graft choice. Most participants have not embraced newer techniques such as anterolateral or suture tape augmentation. Return to sports is generally not allowed before 7 months and heavily factors-in return-to-sports testing metrics, suggesting that purely time-based criteria for return to sports is not modern practice among elite sports medicine surgeons.