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Several main mechanisms were suggested by which obesity mediates insulin resistance, including altered secretion patterns of adipocytokines, increased levels of glucocorticoids in visceral fat tissue, and increased secretion of pro-inflammatory agents [35, 37]

Table C-I2 provides an example of using benchmark deciles along with partial achievement points to assign achievement points for the Risk-standardized Acute Cardiovascular-rated Hospital Admission Rates for Patients with Heart Failure under the Merit-based Incentive Payment System administrative claims-based quality measure under our current methodology