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However, it has been observed that the meso-Cl group on the HMCD core structure is displaced by S-nucleophiles under physiological conditions, including the free cysteine residue in serum albumin and glutathione (74, 95, 96)

The main dietary sources of L-Carnitine are red meat, fish, poultry, and dairy products

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However, we note that it is not necessary to include Medicare Advantage IME payments in the outlier threshold calculation or the outlier offset to the standardized amount because the statute requires that outlier payments be not less than 5 percent nor more than 6 percent of total operating DRG payments, which does not include IME and DSH payments