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Furthermore, these pharmacokinetic alterations are likely attributable to modulations in absorption and metabolism mediated by factors including gut microbiota composition, endogenous biomolecules, enzyme activity, and transmembrane transport efficiency (116)

For this reason, we stated in the proposed rule that we believe requiring hospitals to include NPIs that meet our proposed criteria would not pose a significant burden or, for most hospitals, significantly increase the amount of data stored in the MRFs

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