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2 Seventy-five90% of patients with B12 deficiency present with neurological complications, which may be the only manifestation in up to 25% of cases

Inflammation, repair signaling, angiogenesis, immune modulation, and remodeling occur at the same time

It is particularly common among older demographics, where skin becomes less effective at producing Vitamin D, or among people with darker complexions

Response: We thank commenters for their concern regarding whether the proposed Overall Hospital Quality Star Rating methodology updates adequately address the overall CMS goal of prioritizing patient safety across programs

Abbreviations A: Amyloid- NPY1R: Neuropeptide Y Y1 receptor VIP: Vasoactive intestinal peptide CRH : Corticotropin-Releasing Hormone ACTH : Adrenocorticotropic Hormone CCK: Cholecystokinin DSIP: Delta Sleep-Inducing Peptide GPCR: G protein-coupled receptors References Aguilera G (1994) Regulation of pituitary ACTH secretion during chronic stress