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The Overall Hospital Quality Star Rating methodology would be unchanged through step eight with the exception of redesignating paragraph (d)(5) as (6), and paragraph (d)(6) as (5) (assignment of star ratings using K-means clustering as described previously in this section), with the cap being applied as a new step nine: Any hospital that is assigned 5 stars in step eight but has a lowest quartile Safety of Care score (based on at least three Safety of Care measures) would be reassigned to 4 stars

Excipient quality: All excipients must comply with pharmacopoeia standards to ensure they are free of impurities and microbial contamination

(13) Autism spectrum disorder has been associated with problems in how the body makes its own glutathione, resulting in chronically low levels

However, for those at risk (such as those with celiac disease), measures of blood vitamin B 12 levels and, in some cases, preventive therapy with vitamin B 12 may be recommended