The Uniform Custodial Trust Act: An Alternative to Adult Guardianship

The problems associated with court appointed guardianship are axiomatic. The public nature of the court proceeding required for appointment of a guardian is of concern to many families who become involved in the process. The expense and delay associated with the original hearing, as well as subsequent hearings that may be necessary in the operation of the guardianship, are also a great disadvantage of guardianship. As a means of managing property, guardianship is cumbersome, expensive and inflexible. Recently, stories of the expense and potential abuse of guardianship for adults have found their way into the popular press. While most people think of guardianship as relating solely to minors or people adjudicated as mentally incompetent, guardianship may also be necessary for adults who suffer from functional incapacity below a level that would justify a formal adjudication of mental incapacity

Ada and Knowledge-Based Systems: A Prototype Combining the Best of Both Worlds

We describe a software architecture based on Ada tasking and packaging which facilitates the construction of distributed knowledge-based systems. We used this architecture to build the Knowledge-Based Maintenance Expert System (KNOMES) prototype for the Remote Manipulator System (RMS) of the NASA Space Station Mobile Service Center. Each module of the system contains Ada packages of standard systems services, which interface with an artificial intelligence/ knowledge-based system (AI/KBS) language component that performs knowledge-based reasoning. By using Ada as the fundamental structure, we achieved a well-structured, maintainable program; by retaining the AI/KBS language component, we were able to capture the knowledge needed to solve illstructured, dynamic, and/or nonalgorithmic problems

Porous materials show superhydrophobic to superhydrophilic switching

Switching between superhydrophobicity and superhydrophilicity in porous materials was predicted theoretically and demonstrated experimentally with the example of thermally induced contact angle change; tunability of this system was also demonstrated

Treatment utilization and outcomes in elderly patients with locally advanced esophageal carcinoma: A review of the National Cancer Database

For elderly patients with locally advanced esophageal cancer, therapeutic approaches and outcomes in a modern cohort are not well characterized. Patients ≥70 years old with clinical stage II and III esophageal cancer diagnosed between 1998 and 2012 were identified from the National Cancer Database and stratified based on treatment type. Variables associated with treatment utilization were evaluated using logistic regression and survival evaluated using Cox proportional hazards analysis. Propensity matching (1:1) was performed to help account for selection bias. A total of 21,593 patients were identified. Median and maximum ages were 77 and 90, respectively. Treatment included palliative therapy (24.3%), chemoradiation (37.1%), trimodality therapy (10.0%), esophagectomy alone (5.6%), or no therapy (12.9%). Age ≥80 (OR 0.73), female gender (OR 0.81), Charlson-Deyo comorbidity score ≥2 (OR 0.82), and high-volume centers (OR 0.83) were associated with a decreased likelihood of palliative therapy versus no treatment. Age ≥80 (OR 0.79) and Clinical Stage III (OR 0.33) were associated with a decreased likelihood, while adenocarcinoma histology (OR 1.33) and nonacademic cancer centers (OR 3.9), an increased likelihood of esophagectomy alone compared to definitive chemoradiation. Age ≥80 (OR 0.15), female gender (OR 0.80), and non-Caucasian race (OR 0.63) were associated with a decreased likelihood, while adenocarcinoma histology (OR 2.10) and high-volume centers (OR 2.34), an increased likelihood of trimodality therapy compared to definitive chemoradiation. Each treatment type demonstrated improved survival compared to no therapy: palliative treatment (HR 0.49) to trimodality therapy (HR 0.25) with significance between all groups. Any therapy, including palliative care, was associated with improved survival; however, subsets of elderly patients with locally advanced esophageal cancer are less likely to receive aggressive therapy. Care should be taken to not unnecessarily deprive these individuals of treatment that may improve survival