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Bonsai is a cultural tradition with roughly 1,300 years of history in Japan, recognized and appreciated across the world. One of the most prized subjects in bonsai is the Sargent juniper (Juniperus chinensis var. sargentii), called ‘shimpaku’ in Japanese. A particularly well-regarded variety of shimpaku was discovered in Itoigawa in the early 20th century. The ‘Itoigawa Shimpaku’ is prized for its tightly bunched leaves, beautiful white wood and exceptional hardiness. It thrives in the rugged mountains of Itoiga-wa which formed along the Itoigawa-Shizuoka Tectonic Line, a massive fault closely connected to the formation of the Japanese island arc. After decades of collection, the Itoigawa Shimpaku has largely disappeared from its native habitats. Aging local communities are unable to manage the tree’s native mountains and forests. Furthermore, younger generations are less interested in traditional arts making the future of the Itoigawa Shimpaku increasingly uncertain. In response to these issues, Itoigawa UNESCO Global Geopark launched the Itoigawa Shimpaku Project to engage local commu-nities in how best to preserve this unique local heritage and to share it with a wider audience through community-led, experience-oriented tourism programs which link geological, natural and cultural heritage. The aim of this project is to encourage sustainable development, raise new generations of bonsai practitioners and promote responsible management of forests and mountains to en-sure the Itoigawa Shimpaku’s future for centuries to come. This paper will discuss the history of the Itoigawa Shimpaku as well as the background, main issues, and the current progress and future plans of the Itoigawa Shimpaku Project.

Overactive bladder (OAB) is experienced by more than half of patients with untreated Parkinson's disease. Treatment of overactive bladder in these patients has included antimuscarinic anticholinergics, raising concerns about the possibility of exacerbating cognitive impairment or constipation. Mirabegron (Myrbetriq), a β3-receptor agonist, provides relief of OAB without increasing cognitive impairment. While prior studies have examined the effect of mirabegron on OAB in a variety of patient populations, this study is the first controlled, prospective study investigating the effect of mirabegron on overactive bladder in patients with Parkinson's disease. By studying effective treatments for overactive bladder, this trial emphasizes the importance of antimicrobial stewardship so that lower urinary tract symptoms are not treated as lower urinary tract infections with antimicrobials and instead overactive bladder can be treated appropriately with medication. The MAESTRO study compared the effect of adding mirabegron to behavioral modification (including pelvic floor exercises) to behavior modification alone. Results from this novel study show that both the mean absolute change in the volume of micturition (objective measure) and the mean percent change increased significantly between visits two and three in the experimental group using mirabegron. Moreover, improvements in micturition in this study indicate that a larger-scale study of mirabegron with pelvic floor exercises and behavior modification is warranted.

A "plated bullet" has a thin layer of electroplated metal covering the lead core of the projectile. In certain situations, this thin layer of electroplated metal can fracture upon discharge of the firearm. When such fracturing occurs, vaporous lead can escape through the fracture lines of the spinning projectile, resulting in a spiral-shaped deposition of dark residue surrounding a central bullet defect. The spiral-shaped pattern is referred to as "comet-tailing," or the "vortex effect." In this report, three homicide cases with associated comet-tailing are presented. Police, death investigators, and forensic pathologists should be aware of this unique finding.

The contribution of positional asphyxia in opioid-related deaths is currently unknown. Diagnostic criteria for positional asphyxia include finding the decedent in a position that does not allow for adequate respiration and an inability to extricate themselves from the position due to various conditions. Our primary objective was to assess whether positional asphyxia and the resulting airway compromise were a contributing factor to death due to the toxic effects of opioids. We evaluated 225 deaths where the death scene investigation contained adequate information to evaluate for positional asphyxia and performed a Pearson chi-square test to determine if the proportion of deaths found in an airway compromising position was higher when opioid(s) caused the death. The proportion of decedents found in a potential airway compromising position was greater when the death was related to opioid use (p < 0.0001). Further, narrowing the dataset to decedents who were definitely in an airway compromising position [Yes (24.49%) vs. No (11.02%)] showed a statistically significant association between positional asphyxia and deaths related to opioid use (p = 0.0021). Carefully documenting the position in which the decedent was initially found may be a significant factor in accurate reporting and in harm reduction efforts to decrease the opioid mortality rate.

While fire-related deaths are regularly encountered by medical examiners, fire-related homicides are relatively uncommon. Although some large retrospective studies of fire-related deaths have been performed, few large studies have specifically reviewed fire-related homicides. Autopsy, scene investigation, and ancillary studies were reviewed for 38 fire-related homicides evaluated at the Wayne County Medical Examiner’s Office in Detroit, Michigan. The largest proportion of cases were inhalation-related deaths in dwelling fires (n = 21, 55%), followed by deaths from thermal injury after immolation (n = 8, 21%) and traumatic death with contemporaneous or subsequent immolation (n = 8, 21%). There was one case of postmortem immolation. Although carboxyhemoglobin (COHb) levels played a significant role in evaluation of these cases, no single factor was diagnostic of a particular cause or manner of death. Fire-related homicides present unique diagnostic challenges because multiple insults frequently contribute to the cause death. Death at the scene and COHb level above 10% are the most useful factors in establishing smoke and soot inhalation as the cause of death. Some autopsy findings are helpful in establishing or ruling out smoke and soot inhalation as contributing to or sole cause of death, but an evaluation of the entire circumstances and autopsy findings is necessary.

Residential fires are a significant cause for morbidity and mortality in the United States. Death is often the result of soot and smoke inhalation causing carbon monoxide (CO) toxicity. The approximate lethal level of carboxyhemoglobin (COHb) in healthy adults has been well described. However, a significant number of medical examiner cases involve infirmed decedents, often elderly, with complex cardiovascular disease burdens. It is well known that death in these cases will occur at sublethal levels of COHb; however, increased lethality has been largely documented via anecdotal experience and lacks quantification. Fifty-five cases were identified where death resulted from smoke and soot inhalation suffered in a residential fire. The control group, with no cardiovascular disease, had an age-adjusted mean COHb level of 61.6% at the time of death. Presence of hypertensive cardiovascular disease showed a 30% reduction in COHb (age-adjusted mean 43.2%), atherosclerotic disease showed a 33% reduction (age-adjusted mean 41.5%), and combined disease presentation accounted for 41% reduction (age-adjusted mean 36.3%). When controlling for age, atherosclerotic and hypertensive cardiovascular diseases were each associated with statistically significant decreases in COHb (p < 0.01). Increasing age was associated with decreased COHb levels at 2.8% per 10 years of life (p < 0.01), even when modeled with hypertensive and atherosclerotic disease. These findings carry important public health significance, as well as practical significance for the medical examiner when interpreting COHb levels in cases of suspected deaths due to smoke and soot inhalation.

Our aim was to determine if the time interval between bowel resection and initiation of adjuvant chemotherapy impacts survival in advanced ovarian cancers.This was a retrospective cohort study using data from two cancer centers, Princess Margaret Cancer Centre in Toronto, Ontario, Canada and Samsung Comprehensive Cancer Center in Seoul, South Korea. Patients with International Federation of Gynecology and Obstetrics (FIGO) stage III or IV ovarian cancer that underwent large bowel resection during primary cytoreductive surgery (PCS) were included.Ninety-one women were eligible of which the majority (90.1%) were diagnosed with high-grade serous cancer. The median interval from PCS to chemotherapy for all patients was 21 days (7-86 days). Patients were stratified into 3 groups: 1) Interval ≤14 days, 32 (35.2%) patients; 2) Interval between 15-28 days, 27 (29.6%) patients; and 3) Interval between 29-90 days, 32 (35.2%) patients. Surgical procedures and postoperative outcomes were similar between groups. Multivariate analysis indicated that PCS to chemotherapy interval of 2-4 weeks, younger age, and completion of 4 or more adjuvant chemotherapy cycles were independent prognostic factors of favorable overall survival.Initiation of adjuvant chemotherapy between 2 to 4 weeks after PCS with bowel resection may improve survival outcomes in women with advanced ovarian cancer by maximizing the benefit of PCS plus adjuvant chemotherapy.

The majority of hanging deaths are relatively straightforward when opining the manner of death, typically determined to be suicide. However, there are rare hanging deaths that require the forensic pathologist to seek additional information. Forensic pathologists commonly consider an accidental manner of death when the hanging death scene includes evidence of solitary sexual activity consistent with autoerotic asphyxia. Here, the authors present a case of an initially apparent suicidal hanging where important death scene details photographed by the medical examiner investigator and history provided by family members during subsequent conversations ultimately helped the forensic pathologist conclude an opinion that the hanging was accidental, likely due to autoerotic activity. The decedent, who hanged himself in the closet of his bedroom, was wearing shorts that were initially believed to be inadvertently torn; however, further investigation revealed his shorts were intentionally modified to expose his genitalia. Additional evidence documented from the death scene photographs and conversations with his mother revealed items and activities consistent with autoerotic behavior. Before opining a manner of death in hanging deaths, forensic pathologists are encouraged to consider details beyond that obtained from the initial death scene investigation and postmortem examination. A thorough medicolegal death investigation should not be viewed as introducing cognitive bias, but rather as necessary information needed to determine the most accurate cause and manner of death.

The majority of opioid-related deaths are accidental. However, the number of opioid-related suicidal deaths is likely under recognized. Presented here is a case of suicide by heroin overdose. The manner of death would have likely been deemed accidental if not for critical information shared by the decedent's family during follow-up telephone interviews between the forensic pathologist and the decedent's family, which included text messages that were sent by the decedent just before his death that were not known at the time of the initial medicolegal death scene investigation. This case highlights that when a forensic pathologist establishes an engaged relationship with the decedent's family, the information elucidated can prove to be invaluable in reaching an informed opinion about the manner of death. For overdose cases, identifying an accurate manner of death allows the design of public health efforts that adequately address the health risks in the community. For aid in the determination of the manner of death for overdose cases, we propose a five-step checklist that may assist forensic pathologists and medicolegal death investigators when approaching similar cases.

Chronic traumatic encephalopathy (CTE) was initially conceptualized in boxers, but has extended to other athletes in recent years, albeit with limited clinical correlations. It is often asserted that CTE pathology represents the substrate for progressive neurodegenerative disease. We report the case of a shotgun injury to the brain with 42-year survival and no neurological disease progression until shortly before death. The decedent had no other traumatic brain injury (TBI) exposure and did not play football or other high energy collision sport. Neuropathological examination confirmed tissue damage, but additionally demonstrated localized patterns of phosphorylated tau (p-tau) meeting criteria for CTE pathology. P-tau and TDP-43 deposits within marginal tissue of damaged brain were also present focally. No amyloid-β (Aβ) deposits were present. These findings indicate that CTE pathology may occur following a single, severe TBI.

In this paper, we propose an energy-efficient, cluster-based routing algorithm to address the issue of energy constraints in wireless sensor networks. There are two components in the proposed model, the first supports the development of clusters and the second helps decide which of the sensors will sleep. Together they improve the lifetime of the clusters. Biologically inspired activator-inhibitor mechanism is employed to form clusters and select cluster heads based on the activator concentration where each sensor is associated with a pair of activator and inhibitor concentration values. In each cluster, a Gur game is applied to determine the set of active sensor nodes while inactive sensor nodes turn to sleep mode for conserving energy. The activator–inhibitor system is known to provide the mechanism for autonomous biological pattern formation, such as spots on mammals’ coats, through interactions between molecules and their diffusion rates. The Gur game is a self-organized artificial game associating voters in the game with finite state automata and a moderator with a reward function. Typically in wireless sensor networks, the base station is considered as the moderator and sensor nodes as voters in the Gur game. To further maximize the lifetime of the network, in our proposed routing algorithm, each cluster is then associated with a Gur game to determine the number of active sensor nodes where the cluster head is regarded as the moderator and the cluster members as voters. Finally, we present preliminary results on the comparison between the proposed routing algorithm and LEACH, a well-known distributed clustering protocol used in wireless sensor networks that shows our method works better than LEACH.

Crossbow fatalities are a rare occurrence, but crossbow use is on the rise. The manner of death in crossbow fatalities is overwhelmingly opined accident or suicide, not homicide. Despite their increasing use and reports of at least 14 crossbow-related homicides in the media for the last 5 years, crossbow homicides are rarely reported in the medical literature; only 10 articles that discussed 20 crossbow homicides were identified in the PubMed database. Here, we describe a case of a 20-year-old man who was found dead in his driveway after being shot in the abdomen with a crossbow by another person. The crossbow bolt had a mechanical 2-blade broadhead that transected the descending aorta and lodged in his vertebra. When completing a medicolegal death investigation and postmortem examination on suspected crossbow-related deaths, knowledge of crossbow components, its utility as a weapon, wound patterns, and how it can cause death are important. This case serves to build on the limited medical literature of crossbow homicides, educate forensic pathologists about the features of crossbow deaths, and highlight manner of death considerations.

The obesity epidemic and its associated comorbidities present a looming challenge to health care delivery throughout the world. Obesity is characterized as a sterile inflammatory process within adipose tissues leading to dysregulated secretion of bioactive adipokines such as adiponectin and leptin, as well as systemic metabolic dysfunction. The majority of current obesity research has focused primarily on preclinical animal models in vivo and two-dimensional cell culture models in vitro. Neither of these generalized approaches is optimal due to interspecies variability, insufficient accuracy with respect to predicting human outcomes, and failure to recapitulate the three-dimensional (3D) microenvironment. Consequently, there is a growing demand and need for more sophisticated microphysiological systems to reproduce more physiologically accurate human white and brown/beige adipose depots. To address this research need, human and murine cell lines and primary cultures are being combined with bioscaffolds to create functional 3D environments that are suitable for metabolically active adipose organoids in both static and perfusion bioreactor cultures. The development of these technologies will have considerable impact on the future pace of discovery for novel small molecules and biologics designed to prevent and treat metabolic syndrome and obesity in humans. Furthermore, when these adipose tissue models are integrated with other organ systems they will have applicability to obesity-related disorders such as diabetes, nonalcoholic fatty liver disease, and osteoarthritis. IMPACT STATEMENT: The current review article summarizes the advances made within the organ-onchip field, as it pertains to adipose tissue models of obesity and obesity-related syndromes, such as diabetes, non-alcoholic fatty liver disease, and osteoarthritis. As humanized 3D adipose-derived constructs become more accessible to the research community, it is anticipated that they will accelerate and enhance the drug discovery pipeline for obesity, diabetes, and metabolic diseases by reducing the preclinical evaluation process and improving predictive accuracy. Such developments, applications, and usages of existing technologies can change the paradigm of personalized medicine and create substantial progress in our approach to modern medicine.

Obesity, defined as a body mass index of 30 kg/m2 or above, has increased considerably in incidence and frequency within the United States and globally. Associated comorbidities including cardiovascular disease, type 2 diabetes mellitus, metabolic syndrome, and nonalcoholic fatty liver disease have led to a focus on the mechanisms promoting the prevention and treatment of obesity. Commonly utilized in vitro models employ human or mouse preadipocyte cell lines in a 2-dimensional (2D) format. Due to the structural, biochemical, and biological limitations of these models, increased attention has been placed on “organ on a chip” technologies for a 3-dimensional (3D) culture. Herein, we describe a method employing cryopreserved primary human stromal vascular fraction (SVF) cells and a human blood product-derived biological scaffold to create a 3D adipose depot in vitro. The “fat-on-chip” 3D cultures have been validated relative to 2D cultures based on proliferation, flow cytometry, adipogenic differentiation, confocal microscopy/immunofluorescence, and functional assays (adipokine secretion, glucose uptake, and lipolysis). Thus, the in vitro culture system demonstrates the critical characteristics required for a humanized 3D white adipose tissue (WAT) model.

The diagnosis of acute pancreatitis, which can occur due to natural and nonnatural causes, is usually made at autopsy based on gross and microscopic examination. However, some pathologists choose to measure serum amylase and lipase levels in postmortem blood samples, which may provide corroborating evidence of acute pancreatitis when evaluated in the context of the autopsy findings. A small series of autopsy cases of deaths related to acute pancreatitis with corresponding postmortem serum amylase and lipase levels and a review of the literature are used to highlight the potential benefits and interpretation issues of postmortem serum amylase and lipase. In autopsies without decomposition, elevated postmortem serum amylase (greater than 1000 U/L) and lipase can provide supportive evidence of acute pancreatitis as a cause of death. However, relying on postmortem serum amylase and lipase alone to diagnose acute pancreatitis is insufficient and unreliable. Rather, one must have the gross and histologic evidence of acute pancreatitis. Acad Forensic Pathol. 2018 8(2): 311-323

Considering the human resources, time and energy expenditures in the modern technology of today, efficient use of resources provides significant advantages in many ways. As a result of this, the role of intelligent building systems, which are part of the campuses and cities, is becoming much more important day by day. The purpose of these building systems is to ensure that the resources and systems are efficiently used in order to provide comfortable living conditions to the people. For this purpose, in this paper, we investigate the ways to improve the efficiency of the energy used by these buildings. In this study, we use the Long Short Term Memory (LSTM) neural network model to analyze the energy expenditures of the buildings that reside in the campuses of the City University of New York (CUNY). With the help of the neural network model that had been developed, we aim to predict the energy consumption values of these buildings in order to obtain energy efficient smart buildings.

Organizations in various sectors of diverse domestic and global industries (profit and not-for-profit) (public or private) such as business, education, government, healthcare, military, religious, etc. operate in very competitive environments that require the highest levels of excellence in operational standards. Indicators of outstanding organizations (germane to a particular industry) may tend to use measurements such as an entity’s certified audit reports; competitive advantage; financial indicators, market share; growth, expansion and/or retention; profitability; shareholder investment returns; stakeholder engagement and customer satisfaction surveys. Benchmarks to achieve these standards may also be found in gold star instruments such as the Malcolm Baldridge Award, Good-to-Great Organizations and Industry Best Practices. The basis for this qualitative exploration was instigated by sentiments that Seventh-day Adventist (SDA) local conferences may also aspire to emulate standards of excellence that are expected and exemplified in other exemplary organizations. Three critical questions this study will address are: (1) What are possible criteria and standards of organizational excellence and effectiveness? (2) What comprises an organization’s effectiveness system? (3) What are the attributes of an effective and efficient organization? A qualitative design was utilized with data for this study selected, collected and analyzed (coding, patterns, trends and themes) from extensive open-ended questionnaires to targeted populations of NAD and Union conference CEOs (Chief Executive Officers/Presidents), CAOs (Chief Administrative Officers/Executive Secretaries) and CFOs (Chief Financial Officers/Treasures) N=30 throughout Canada and the United Stated of America (USA) with a participant response rate of N=13 or 43%. Discussion, Implications, Conclusion and Recommendations are also discussed.

The basis of this qualitative examination was incited by the notion that the perceptions of Seventh-day Adventist (SDA) Local Conference leadership substantially effects how the relationships of Chief Financial Officers (CFOs/Treasurers) and Chief Executive Officers (CEOs/Presidents) are viewed and function as members of their conference leadership team . In the past, Chief Financial Officers (CFOs) and Chief Executive Officers (CEOs) have historically functioned in their own professional executive compartments within their organizations rather than partnering together as cooperative teammates. The 21 st Century’s, however, has forever changed how CFOs and CEOs relate to each other in the workplace due to the inception of governmental regulations called the Sarbanes-Oxley Act which was passed to address major corruption in large USA businesses and organizations, major non-compliance in accounting practices, extensive financial reporting fraud, institutional mis-management, board governance, CFO and CEO accountability. The impact of Sarbanes-Oxley has also influenced the relational practices of CFOs and CEOs in Seventh-day Adventist (SDA) conferences. A Mixed-Methods sequential exploratory research design was used with primary data for this study purposefully selected, collected and analyzed (coding, patterns, trends and themes) from qualitative focus group interviews with four local conference CFOs and CEOs, N=8, located in the United Stated of America (USA). Discussion and Conclusion are explored and disclosed, and the Implications of CFO and CEO relationship on organizational effectiveness, efficiency, and climate are presented.