Outpatient total hip arthroplasty.

Patients younger than 65 years were studied to determine what percentage of patients would enroll in a study of outpatient total hip arthroplasty, its safety, and benefits of the program. Of 192 eligible patients, 69 (36%) enrolled, and 53 (77%) of these went home the same day of surgery. Of 53, 44 maintained a diary for the first 3, weeks and 52 completed a satisfaction questionnaire at 6 weeks. Patients were followed for 6 months for occurrence of complications. There were no medical readmissions. Of 52 patients who completed a 6 week questionnaire, 50 (96%) were satisfied with the decision to have outpatient total hip arthroplasty. There were no objective physical benefits identified. This study reports the distribution of acceptance and completion of same day discharge for patients with total hip arthroplasty in a metropolitan population. It confirms safety in selected patients.

Evidence for deep-water production in the North Pacific Ocean during the early Cenozoic warm interval.

The deep-ocean circulation is responsible for a significant component of global heat transport. In the present mode of circulation, deep waters form in the North Atlantic and Southern oceans where surface water becomes sufficiently cold and dense to sink. Polar temperatures during the warmest climatic interval of the Cenozoic era (approximately 65 to 40 million years (Myr) ago) were significantly warmer than today, and this may have been a consequence of enhanced oceanic heat transport. However, understanding the relationship between deep-ocean circulation and ancient climate is complicated by differences in oceanic gateways, which affect where deep waters form and how they circulate. Here I report records of neodymium isotopes from two cores in the Pacific Ocean that indicate a shift in deep-water production from the Southern Ocean to the North Pacific approximately 65 Myr ago. The source of deep waters reverted back to the Southern Ocean 40 Myr ago. The relative timing of changes in the neodymium and oxygen isotope records indicates that changes in Cenozoic deep-water circulation patterns were the consequence, not the cause, of extreme Cenozoic warmth.