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The Spine Journal Official Journal of the North American Spine Society 15 (5), 10281033

While blood tests like homocysteine and MCH can indicate issues, intracellular testing is the most definitive way to diagnose a deficiency

Mechanical thermostatic mixing valve (TMVs) have been in use for the past 100 years and have changed little, short of adding paraffin to the actuator instead of liquid, chemical filled, or bi-metal coils