Medium‐Chain Acyl‐CoA Dehydrogenase Deficiency in Adulthood: A Potential Diagnosis in a Patient with Mental Status Changes Suspected of Drug Toxicity

Medium‐chain acyl‐CoA dehydrogenase (MCAD) deficiency is a rare but important component of the differential diagnosis for adults with a history of premortem mental status changes and the postmortem finding of hepatic steatosis. This case report describes a 30‐year‐old white man who, following a period of nausea and vomiting, was admitted to the hospital with sudden mental status deterioration followed rapidly by clinical deterioration and death. Treating physicians in this case suspected acute illicit drug toxicity with synthetic cathinones based on social history. Clinicians and medical examiners should be aware that the presentation, signs, and symptoms described may indicate an underlying inborn error of metabolism such as MCAD deficiency and take action accordingly.     

Radical Transactionalism: Legal Consciousness,Diverse Economies,and the Sharing Economy

This article proposes an original theoretical approach to the analysis of community‐level action for sustainability, focusing on its troubled relationship to the sharing economy. Through a conversation between scholarship on legal consciousness and diverse economies, it shows how struggles over transactional legality are a neglected site of activism for sustainability. Recognizing the diversity of economic life and forms of law illuminates what we call ‘radical transactionalism': the creative redeployment of legal techniques and practices relating to risk management, organizational form, and the allocation of contractual and property rights in order to further the purpose of internalizing social and ecological values into the heart of economic exchange. By viewing sharing‐economy initiatives ‘beyond Airbnb and Uber’ as sites of radical transactionalism, legal building blocks of property and capital can be reimagined and reconfigured, helping to construct a shared infrastructure for the exercise of collective agency in response to disadvantage sustained by law.     

“I Got Your Back”: Friends’ Understandings Regarding College Student Spring Break Behavior

Behaviors that pose threats to safety and health, including binge drinking and unprotected sex, increase during a week-long break from university. Understandings with peers regarding these behaviors may be important for predicting behavior and related harms. College students (N = 651; 48% men) reported having understandings with their friends regarding alcohol use (59%) and sexual behavior (45%) during Spring Break. These understandings were to engage in behaviors characterized by risk (e.g., get drunk [23.5%], have sex with someone new [5.2%]) and protection (e.g., drink without getting drunk [17.8%], use condoms [15.8%]). After controlling for previous semester behavior and going on a Spring Break trip, Get Drunk Understandings predicted a greater likelihood of binge drinking and alcohol-related consequences; No/Safe Sex Understandings predicted condom use; and Sex Understandings predicted not using condoms. Understandings with friends regarding Spring Break behavior may be important proximal predictors of risk behaviors and represent potential targets for event-specific prevention.