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.     

The ‘Hybrid Order’: origins and usage

The hospital direction (Hybrid Order) was inserted into the Mental Health Act (MHA) in 1997 (Crime (Sentences) Act, 1997). It enables higher courts to direct hospital admission for offenders, whilst still imposing a prison sentence. The origins of the ‘Hybrid Order’ and its patterns of usage are examined. Comparisons are made with its Scottish equivalent, Section 59A of the Criminal Procedure (Scotland) Act 1995. Both the ‘Hybrid Order’ and Section 59A have been used infrequently. This may reflect the fact that they were strongly resisted on ethical grounds at their point of inception and that they force the psychiatrist into the position of ‘punisher’, rather than ‘treater’. Since the 2007 Amendment of the MHA in England and Wales which expanded the remit of the ‘Hybrid Order’ to include all legal categories of mental disorder, not solely psychopathy, its use has unsurprisingly increased – this article delineates the considerations that need to be given in its recommendation.     

The Russian Dance with Democracy

An American political scientist investigates whether, and how, the political and economic values of ordinary Russians have changed. The study is based on a three-wave panel survey of a representative national sample of Russians, conducted between 1996 and 2000. The article considers the degree to which democratic commitments have solidified over the last half of the decade. The article also tests the conventional wisdom that democratic values are dependent upon perceptions of a successful economy.     

Shorter notices

Extension in Rural Communities. By A. H. Savile. Oxford University Press, 1965. Pp. 143. 21/‐.

The Financial Sector and Economic Development: The Mexican Case. By Robert L. Bennett. Oxford University Press, 1965. Pp. 244. 56/‐.

The Wretched of the Earth. By F. Fanon. MacGibbon & Kee, London, 1965. Pp. 255. 36/‐.

The Sierra Leone Diamonds By H. L. Van der Laan. Oxford University Press, London, 1965. Pp. 228. 25/‐.

Some Economic Aspects of Business Organisation. By James E. McNulty. University of Pennsylvania Press,Philadelphia. Pp. 122.40/‐.

Farming as a Business. By M. Upton and Q. B. O. Anthonio. Oxford Tropical Handbooks. Oxford University Press, 1965. Pp. 133. 21/‐.     

The Pacific Rim

Korea: Managing the Industrial Transition, Vol. 1: The Conduct of Industrial Policy. By D.M. Leipziger and others (World Bank Country Study). Washington: World Bank, 1987. Pp.xiv + 182. US$10. ISBN 0 8312 0887 4.

Public Intervention and Industrial Restructuring in China, India and the Republic of Korea. By Amiya Kumar Bagchi. New Delhi: International Labour Organization (Asian Employment Programme, ARTEP), 1987. Pp.xii + 162. US$8. ISBN 92 2 105774 7.

Policy Options for the Singapore Economy. By Lim Chong Wan and Associates. Singapore: McGraw Hill, 1988. Pp.xv + 499. US$29.95. ISBN 0 07 099133 2.

The Political Economy of the New Asian Industrialism. Edited by Frederic C. Deyo. Ithaca and London: Cornell University Press, 1987. Pp.252. US$32.95 + $14.25. ISBN 0 8014 9449 4.

Financing East Asia's Success: Comparative Financial Development in Eight East Asian Countries. By Michael T. Skully and George J. Viksnins. London: Macmillan Press in association with the American Enterprise Institute for Public Policy Research, 1987. Pp.xii + 242. £29.50. ISBN 0 333 42655 X.     

A Tangled Web: Complexity and Inequality in the English Local Government Finance Settlement

The £29 billion formula grant stands at the heart of the English local government finance system. This transfer of resource from central to local government has, since 2006–07, been distributed using the so-called ‘four block model’. This extraordinarily complex formula-based funding mechanism aims to ensure that all local authorities are able to provide individuals with a broadly comparable level of public service – offering greatest support to local authorities with high service needs and/or low capacity to raise revenue. This paper outlines the structure and workings of the four block model and, drawing attention to key methodological shortcomings, explains why the resulting distribution of the formula grant is both arbitrary and inequitable. In particular it argues that key model parameters – specifically the need and resource equalisation proportions – are set in order to fulfil a particular funding outcome. This flies in the face of the basic tenets of resource allocation methodology in that, being outcome-led, the approach is clearly neither need-based nor impartial. The paper argues that the four block model fails to meet its own goal of fiscal equalisation, is likely to lead to increasing service disparities, and must be replaced as a matter of urgency.     

Book reviews

Ephraim Maisel, The Foreign Office and Foreign Policy 1991–1926 (Brighton: Sussex Academic Press 1994), £35. ISBN 1–898723–04–4.

Timothy P. Maga, The World of Jimmy Carter: U.S. Foreign Policy 1977–1981 (West Haven, CT: University of New Haven Press, 1994). 189 pp. ISBN 0–936385–23–0.

Michael Leifer, Dictionary of the Modern Politics of South‐East Asia (London and New York: Routledge, 1995), xii + 271pp. £45. ISBN 0–415–04219–4.

Christopher C. Harmon and David Tucker (eds.), Statecraft and Power: Essays in Honor of Harold W. Rood (Lanham and London: University Press of America with the National Institute for Public Policy, 1994), 284pp ISBN 0–8191–8718–6.     

Hanging the Kaiser: Anglo‐Dutch relations and the fate of Wilhelm II, 1918–20

The flight of the German Kaiser to the Netherlands at the end of the First World War led to a crisis in Anglo‐Dutch relations. Prime Minister David Lloyd George made the trial of the Kaiser a key issue in the British general election campaign of December 1918. Article 227 of the Treaty of Versailles called for the Kaiser's surrender by the Netherlands government for trial before an international tribunal, a request the Dutch repeatedly refused during the period January to March 1920. Using both British and Dutch sources, this article highlights the internal Dutch debate over the fate of the Kaiser, and the confusion and hypocrisy with which the problem was handled by the British government.