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The reason is that only one nucleotide substitution is needed relative to the subtype 1a sequence to generate this variant, whereas two substitutions are needed relative to the 1b sequence (codon usage bias)

This makes it hard to set a standard dose

A commenter urged CMS to work closely with hospitals that voluntarily report the measure to determine if the measure is feasible for broader implementation across CMS quality reporting programs

Spreading 180+ grams across 6 meals means roughly 30 grams per eating occasion, which is far more manageable than trying to consume 60+ gram protein meals when appetite is suppressed