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Assuming that the medical literature indicates that the particular off-label use is in accordance with prevailing professional standards, the regulatory status of the drug is not material to the patient s decision (Beck, 1999) However, once a drug is developed for a speci c group of individuals with a particular genotype or racial or ethnic background (Exner et al, 2001), physicians using the drug for other groups not speci ed by the manufacturers could subject physicians to the risk of liability The risk of some form of medical liability might make off-label use uncommon for the products of pharmacogenomics or at least force professionals to treat the use of the drug in nonspeci ed groups as experimental Medical liability doctrines, of course, put the levers of control in the hands of individuals rather than regulators.

All members of MutexImp are protected, so this class cannot be used on its own. It can, however, be used as a base class for Mutex. Private inheritance from MutexImp ensures that nothing but Mutex gets access to the members of MutexImp. The de nition and implementation of Mutex therefore looks as follows:

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If these two formulas are relatively simple, their application requires us to know more about the stochastic process, as will be seen in the next sections. These formulas can be generalized to every performance index independent of the behavior of the process before the last renewing instant (e.g. the elapsed time since the last renewing instant). 9.2.3. Discrete time Markov chains 9.2.3.1. Presentation A discrete time Markov chain (DTMC) has the following characteristics: The time interval between instants Tn is the constant 1. The next state following the current state only depends on this state and the transition probabilities are constant over time: Pr Xn+1 = sj | X0 = si0 , . . . , Xn = si = Pr(Xn+1 = sj | Xn = si ) = pij = P[i, j] We will use both notations for state transitions. The process is characterized by its initial distribution 0 and matrix P. If n is the distribution of Xn then n = 0 .Pn .

Liability and regulation both have their limitations as means of optimizing the risks and bene ts of innovation in disease management A comparative institutionalist approach does not necessarily endorse adjudication associated with liability over regulations Rather, the approach only points out the relevant advantages and disadvantages of each approach that ultimately will be tested empirically (Komesar, 1994) The one social advantage of medical liability over regulation at this point in time is that it keeps visible the social and historical challenges that pharmacogenomics must overcome Although science wants to speak of human variation in terms of genotype, the social reality is that those genotypes are often associated with socially and historically constructed ethnic and racial groups Ironically, the overall implication of the Human Genome Project is that, from a genetic perspective, human beings are essentially the same; pharmacogenomics is interested in that small variation (Rothstein and Epps, 2001).

For it is in the variation that the safety and risks of drugs can be determined in the era of pharmacogenomics Given our social construction of race and ethnicity, it will be the social groups who are interested in genetic health that will most likely want to monitor the pharmacogenomics revolution Or put another way, knowing which proteins react adversely with other molecules in our bodies does not yet have much social meaning But knowing that the protein.

This section provides a brief overview of OSI layer 1 (ie, the physical layer) and discusses the con gurable knobs that it provides in a typical mobile ad hoc networking environment Two key con gurable knobs at the physical layer are identi ed, namely, (a) transmission power and (b) rate control (via modulation schemes) Each of them are discussed below, along with an explanation of how they can be manipulated to improve network performance 6511 Transmission Power A fundamental quantity that belongs to the physical layer but permeates all layers above it is the transmission power Clearly, the choice of a power level directly impacts the range of a transmission link.

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Similar developments as seen in fixed-line networks are also appearing in mobile networks with a delay of about five years. In fixed networks the number of people using the network not only for voice telephony but also to connect to the Internet is increasing as steadily as the transmission speeds. While the first modems that were used in the mid-1990s featured speeds of about 14.4 kbit/s, the latest generation of modems achieve over 50 kbit/s in the downlink direction. Another incredible step forward was made around the year 2002 when technologies like cable and ADSL modems reached the mass market and dramatically increased transmission speed for end users. With these technologies, transmission speeds of several megabits per second are easily achieved.

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