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Women taking tamoxifen who still have a uterus are at a higher risk of developing endometrial hyperplasia and endometrial carcinoma (risk ratio of 2.53) compared to patients who took placebo in a randomized trial.8 Other casecontrolled studies have also shown an increased risk of developing endometrial hyperplasia while on tamoxifen, especially for postmenopausal women.29 Despite this, the absolute risk of endometrial cancer in a woman on tamoxifen is less than 1 in 1000.11 Therefore, women on tamoxifen should be counseled about their increased risk of both endometrial hyperplasia and carcinoma, and any woman taking tamoxifen should be instructed to report any abnormal vaginal bleeding, especially if she is postmenopausal.16 Premenopausal women appear to have no difference in the rates of endometrial hyperplasia or carcinoma while on tamoxifen and therefore
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is the remaining 90 percent that interests me. The 5 percent who do not need controls must accept them as the cost of doing business. The 5 percent that may try to evade them must be identified and dealt with in an appropriate manner. For the remaining 90 percent, controls are certainly constraints on their behavior but also, I would hope, instructive in explaining the organization s view of how one is expected to comport one s self. They are designed and in place as a ready reference guide, to be consulted when uncertainty or temptation appears. Perhaps Leuci has done us a great service in suggesting we resist the temptation to focus on the anomalies the good and the evil and pay most attention to the middle. When thinking about the law enforcement concepts we have discussed, especially in New York City, one is tempted to think about numbers. Numbers, indeed, may impede an effective controls program. One may be persuaded that while the NYPD was able to effect some impressive innovations and reduce crime by a significant amount, they are also a huge organization. Much bigger than any internal audit function of which I am aware. There is substance to this argument, but we must not let it oversimplify our thinking. Certainly, a three-person audit shop in an organization with 50,000 employees is going to have its hands full and, in that instance, staffing levels may be a legitimate issue on the way to an improved compliance climate. But, let us again think of New York City. The NYPD has, for sake of argument, about 38,000 cops to police a city of roughly 8.5 million. That is a ratio of about 224 to one. Now, to take our mythical organization with 50,000 employees; we would need an audit capability of about 223 people to maintain parity with the cops. Is this likely In my experience, no. Most organizations of that size would be unusual if they had an audit capability of one quarter that size, or 50 people. So, how do we try to be more effective when we may be seriously understaffed For gross understaffing, there is probably no magic answer. It is tough to get five pounds out of a one-pound bag. But, lest we be blinded by pure numbers, we should remember three things: 1. The cops in New York City also have a few more things on their plate than we do, like murder, robbery, rape, drug use, speeding, gang warfare, gambling, prostitution, underage drinking, organized crime, crowd control, guarding VIPs, protection of transit systems, and terrorism, to name but a few. We are dealing with only occupational fraud, although granted, it can occur in a lot of places and in a variety of formats. 2. Policing is a 24/7 type of business. Even though big-city police departments may have an impressive number of officers, they also have to deploy them through three shifts each day, cover holidays and weekends, and also devote substantial numbers to crowd and traffic control at sporting events, concerts, and demonstrations.
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Given that concurrencycontrol managers maygrant multiple locks to different transactions, they have to keep track of which locks they have granted. This is necessary for them to have a basis for future decisions on lock acquisition requests. H ence concurrencycontrol managers associate locksets with every shared object. The lockset will then include a lock for every transaction that has been granted access to an object in a particular mode. The situation when access cannot be granted due to an incompatibility between the requested lock and a previously-granted lock is referred to as a locking conflict. The previously-granted locks that cause the conflict are referred to as conflicting locks. There are
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Fleshing out the Prisoner s Dilemma
The Global Ring Network for Advanced Application Development (GLORIAD) is a facility that provides scientists around the world with advanced networking tools that improve communications and data exchange, enabling active, daily collaboration on common problems. GLORIAD provides large-scale applications support, communication services, large-scale data transport, access to unique scientific facilities, including Grid environments, and specialized network-based tools and technologies for diverse communities of scientists, engineers, and other researcher domains. Currently, GLORIAD has undertaken an expansion plan directed both at building a 10-Gbps hybrid backbone to interconnect national science and engineering networks in the USA, Russia, China, Canada, Korea, and The Netherlands and at creating a switching infrastructure at layer 2 to serve special communities, unique applications with particularly heavy service requirements, and to provide an infrastructure for network research and experimentation. The layer 2 switching infrastructure will eventually evolve into a similar infrastructure for switching layer 1 lightpaths. The GLORIAD network includes special Points of Presence (PoPs) in Chicago, Amsterdam, Moscow, Novosibirsk, Khabarovsk, Beijing, Hong Kong, Hong Kong, and Daejon (South Korea). At layer 1, the transport core of is supported by Multiservice Provisioning Systems (MSPPs). GLORIAD s supporters include the US National Science Foundation, a consortium of science organizations and ministries in Russia, the Chinese Academy of Sciences, the Ministry of Science and Technology of Korea, the Canadian CANARIE network, and The Netherlands SURFnet organization along with some telecommunications services donated by the VSNL telecommunications company. GLORIAD s US home is at the Joint Institute for Computational Science of the University of Tennessee and Oak Ridge National Laboratory (www.gloriad.org).
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