LSCS Holdings Inc. (d/b/a EVERSANA) incurred significant acquisition integration headwinds that contributed to weaker cash flow and higher leverage than our expectations. Based on our updated projections, we now expect leverage of 6x and only minimal free cash flow for 2019. We lowered our issuer credit rating to 'B-' from 'B'. The outlook is stable. We also lowered the issue-level ratings for the first-lien and second-lien credit facility to 'B-' and 'CCC', respectively. The recovery ratings are unchanged at '3' and '6' for the first-lien and second-lien debt, respectively. The stable outlook reflects our expectation for minimal free cash flow generation in 2019. It also reflects our expectation for improved free cash flow generation in 2020 and beyond as the