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Sudden unexpected death of an individual with epilepsy can pose a challenge to death investigators, as most deaths are unwitnessed, and the individual is commonly found dead in bed. Anatomic findings (eg, tongue/lip bite) are commonly absent and of varying specificity, thereby limiting the evidence to implicate epilepsy as a cause of or contributor to death. Thus it is likely that death certificates significantly underrepresent the true number of deaths in which epilepsy was a factor. To address this, members of the National Association of Medical Examiners, North American SUDEP Registry, Epilepsy Foundation SUDEP Institute, American Epilepsy Society, and the Centers for Disease Control and Prevention constituted an expert panel to generate evidence-based recommendations for the practice of death investigation and autopsy, toxicological analysis, interpretation of autopsy and toxicology findings, and death certification to improve the precision of death certificate data available for public health surveillance of epilepsy-related deaths. The recommendations provided in this paper are intended to assist medical examiners, coroners, and death investigators when a sudden unexpected death in a person with epilepsy is encountered.

Sudden unexpected death of an individual with epilepsy (SUDEP) can pose a challenge to death investigators, as most deaths are unwitnessed and the individual is commonly found dead in bed. Anatomic findings (e.g., tongue/lip bite) are commonly absent and of varying specificity, limiting the evidence to implicate epilepsy as a cause of or contributor to death. Thus, it is likely that death certificates significantly underrepresent the true number of deaths in which epilepsy was a factor. To address this, members of the National Association of Medical Examiners, North American SUDEP Registry, Epilepsy Foundation SUDEP Institute, American Epilepsy Society, and the Centers for Disease Control and Prevention convened an expert panel to generate evidence-based recommendations for the practice of death investigation and autopsy, toxicological analysis, interpretation of autopsy and toxicology findings, and death certification to improve the precision of death certificate data available for public health surveillance of epilepsy-related deaths. The recommendations provided in this paper are intended to assist medical examiners, coroners, and death investigators when a sudden, unexpected death in a person with epilepsy is encountered.

ObjectiveTo update the 1997 American Academy of Neurology (AAN) practice parameter regarding sports concussion, focusing on 4 questions: 1) What factors increase/decrease concussion risk? 2) What diagnostic tools identify those with concussion and those at increased risk for severe/prolonged early impairments, neurologic catastrophe, or chronic neurobehavioral impairment? 3) What clinical factors identify those at increased risk for severe/prolonged early postconcussion impairments, neurologic catastrophe, recurrent concussions, or chronic neurobehavioral impairment? 4) What interventions enhance recovery, reduce recurrent concussion risk, or diminish long-term sequelae? The complete guideline on which this summary is based is available as an online data supplement to this article.MethodsWe systematically reviewed the literature from 1955 to June 2012 for pertinent evidence. We assessed evidence for quality and synthesized into conclusions using a modified Grading of Recommendations Assessment, Development and Evaluation process. We used a modified Delphi process to develop recommendations.ResultsSpecific risk factors can increase or decrease concussion risk. Diagnostic tools to help identify individuals with concussion include graded symptom checklists, the Standardized Assessment of Concussion, neuropsychological assessments, and the Balance Error Scoring System. Ongoing clinical symptoms, concussion history, and younger age identify those at risk for postconcussion impairments. Risk factors for recurrent concussion include history of multiple concussions, particularly within 10 days after initial concussion. Risk factors for chronic neurobehavioral impairment include concussion exposure and APOE ε4 genotype. Data are insufficient to show that any intervention enhances recovery or diminishes long-term sequelae postconcussion. Practice recommendations are presented for preparticipation counseling, management of suspected concussion, and management of diagnosed concussion.

The connectivity of river drainages has been decreased by the installation of roadway culverts, particularly for the salmonids of the Pacific Northwest. Thousands of culverts within the State of Washington have been designated by the state DOT as fish passage barriers. Though it is well known that the anadromous salmon travel upstream to spawn, recent evidence suggests that juvenile salmon also travel upstream to seek preferred habitats for feeding, which may ultimately improve their survival at sea. Retrofitting culverts is an economical solution that has been initially implemented to improve adult salmon passage. Baffles increase water depth for low flow conditions and reduce velocities for higher flowrates. To determine the effect of baffles on upstream passage of juveniles, sloped-baffles were studied at a culvert test bed near Tenino, Washington. Using an Acoustic Doppler Velocimeter (ADV), 3-D velocity fields were collected in a full-sized 12.2 m (40’) long, 1.8 m (6’) diameter corrugated culvert. The culvert slope, baffle spacing, and baffle height were varied to observe flow regime trends that describe conditions suitable for fish passage. This project is unique from other hydraulic studies in that biological testing was conducted in conjunction with the hydrodynamic measurements. Biologists randomly selected 100 juvenile Coho salmon from the on-site rearing facility and allowed the fish to ascend the culvert during a three hour period. The movement of the fish was recorded with video cameras and the passage rate was determined.Results indicate that there is considerable spatial variability in the flow created by the baffles within the culvert. The flow is asymmetric, consisting of a jet traveling over the low side of the baffle and an area of re-circulating water on the high side of the baffle. The asymmetry decreases as the discharge increases and the mean water height surpasses the baffle height. The diversity of flow structures created by this asymmetry is important because it increases the number of reduced velocity paths that fish may travel. The fish passage success rates are also consistent with the trends of asymmetry: as the culvert discharge increases fish are limited to fewer possible paths, and passage rates decrease. The results suggest that both the structure of the flow and the average speed of the flow affect the passage rate. We present a scaling equation that relates the occurrence of flow structures to the independent study parameters in order to provide guidance in baffle implementation. Recommendations for future work include further biological interpretation and testing, so that the hydraulic and biological results may be more closely coupled.