Evaluation of serum cortisol in the postmortem diagnosis of acute adrenal insufficiency

Normal adrenocortical activity is necessary for electrolyte regulation and the maintenance of cardiovascular function. Although chronic adrenal insufficiency generally presents with the gradual onset of a set of characteristic symptoms and signs, the more sudden loss of adrenal activity can present with acute, rapidly progressive cardiovascular dysfunction that can be fatal if not recognized and treated promptly. We herein describe a patient who had most of his adrenal tissue removed during resection of metastatic renal carcinoma, conventional clear cell type, with much of the remaining adrenal tissue undergoing necrosis during or shortly after surgery. Although the patient appeared to be stable and progressing adequately well, he died suddenly 2 days postoperatively. When the gross autopsy findings suggested the possibility of adrenal insufficiency, clinical laboratory assessment of adrenocortical activity was sought. Analysis of stored antemortem serum samples and of blood obtained at autopsy demonstrated a progressive decrease in cortisol levels which, in this stressed postsurgical patient, proved fatal. The use of both antemortem and postmortem blood in the demonstration of acute adrenal insufficiency at autopsy is discussed.     

Stepping Out: Rhetorical Devices and Culture Change Management in the UK Civil Service

Organizational culture is the pattern of values and beliefs held by members of an organization and the management of culture is now one of the most frequently discussed of all organizational concepts. The excitement associated with culture is attributable to two factors. First, it is argued that culture is the key to organizational performance; simply stated, a strong organizational culture can be a source of competitive advantage. Second, culture is perceived as an alternative method of control to traditional and technocratic forms of management and can be manipulated to ensure that employees are enthusiastic and committed to organizational objectives.
Despite the extensive interest in this topic, culture remains an elusive concept. This paper investigates the nature of culture and considers strategies for introducing cultural change. Specifically, the aims of the paper are threefold. First, to locate and explain the interests and significance of culture change for the public sector. Second, using a case study of a newly created agency, to investigate the problems and issues affecting cultural change in the civil service. Third, to reassess and critically evaluate the claims for culture management made in the literature. Finally, this paper questions some of the assumptions in the literature, which with few exceptions are biased toward top management and the unitary conception of organization, an ideological frame of reference which is particularly problematic in the public sector.     

A U.S.-China Green Deal?

The year 2020 was a turning point in many ways. A pandemic tested our capacity for international cooperation. Our impact on the changing environment became more urgent.     

Social role playing and moral judgment development

This study examined the relationship between social role playing and moral judgment development. Subjects were 197 students enrolled in introductory social science courses at a public junior/community college in a metropolitan area in southeast Florida. The 78 males and 119 females ranged in age from 17 to 66 years, with a mean age of 22. Rest's (1979a, 1979b) Defining Issues Test (DIT) was used to measure level of moral judgment. Social role playing was measured by the number of separate roles held by subjects in the past or present. Academic aptitude, socioeconomic status, age, and sex were included as control variables. Academic aptitude, age, and social role playing each had significant zero-order correlations with moral judgment, and social role playing added significantly to the explanation of moral judgment, controlling for academic aptitude and age. Implications of these results for the understanding of the development of moral judgment and for intervention programs are discussed.     

Reviews

John N. Hazard, Managing Change in the USSR: The Political‐Legal Role of the Soviet Jurist, Cambridge: CUP, 1983, ix + 182 pp. £17.50.

Martin McCauley (ed.). The Soviet Union after Brezhnev, London: Heinemann, 1983 and New York: Holmes and Meier, 1983, xii + 160 pp. hardback £14.50, paperback £5.50.

Jonathan Haslam, Soviet Foreign Policy 1930–33: The Impact of the Depression, London: Macmillan, 1983, xii + 172 pp. £25.00.

Gavriel D. Ra'anan, International Policy Formation in the USSR: Factional ‘Debates’ during the Zhdanovshchina, foreword by Robert Conquest. Hamden, Connecticut: Archon Books, 1983. Distributed by Leicester UP, xi + 248 pp. £20.00.

Ivan Szelenyi, Urban Inequalities under State Socialism, Oxford: OUP, 1983, x + 158 pp. hardback £15.00, paperback £5.95.

Arvo Tuominen, The Bells of the Kremlin: An Experience in Communism, Hanover and London: University Press of New England, 1983, xvi + 333 pp. $27.00.

Gregory Guroff and Fred V. Carstensen (eds.), Entrepreneur ship in Imperial Russia and the Soviet Union, Princeton, New Jersey: Princeton University Press, 1983, 372 pp. hardback £34.50, paperback £11.30.

Robert C. Horn, Soviet‐Indian Relations: Issues and Influence, New York, Praeger, 1982, xviii+231 pp. hardback $24.95, paperback $8.95.

Stephen R. Sacks, Self‐Management and Efficiency: Large Corporations in Yugoslavia, London: George Allen & Unwin, 1983, xi + 163 pp. £15.00.

C. K. Chase‐Dunn (ed.), Socialist States in the World System. Beverly Hills, Calif.: Sage Publications, 1982, 304 pp. hardback $28.00, paperback $14.00.

David Kideckel (ed.), Political Rituals and Symbolism in Socialist Eastern Europe. Special issue of Anthropological Quarterly, April 1983, vol. 56, no. 2, pp. 52–104. Anthropological Quarterly, 620 Michigan Avenue N.E., Washington D.C. 20064. $5.00.