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PurposeThe purpose of this paper is to investigate whether financial analyst coverage affects the dissemination of disclosed operating lease information into cash flow predictions and stock prices.Design/methodology/approachThe difference in lease expense between capital/finance lease and operating lease reporting is estimated based on the approach in Hsieh and Su (2015). This difference is referred to as the earnings impact from operating lease capitalization and is only available from footnotes. The authors then include the level of financial analyst following in a cash flow model to study its impact on the cash flow predictive value of the earnings impact. Similarly, the level of financial analyst following is inserted in an earnings-return model to assess the effect of analyst coverage on the association between contemporaneous stock returns and earnings impact.FindingsThe authors find that the cash flow predictive value of the earnings impact shifts to the interaction between analyst coverage and the earnings impact, suggesting that the decision-usefulness of the earnings impact is conditioned on the level of analyst following. Nevertheless, the authors find that the earnings impact continues to have explanatory value for the contemporaneous stock returns, while the interaction between analyst coverage and the earnings impact does not. This finding suggests that the earnings impact is already fully reflected in stock prices regardless of analyst following.Research limitations/implicationsSince the estimation of the earnings impact from reporting operating leases as capital leases is based on the method developed by Imhoff et al. (1991), the results and inferences are thus constrained by the validity of the method.Practical implicationsThe authors find that financial analyst activities accelerate the incorporation of the earnings impact from operating lease capitalization in cash flow predictions, but it does not promote the impounding of the earnings impact into stock prices. This finding suggests that financial analysts' influence on the dissemination of the earnings impact hinges on the type of economic activity, and failing to consider the financial analyst following in studying the cash flow predictive value of the earnings impact would obscure the findings.Originality/valueThe authors extend the findings of prior research that financial analysts' activities promote the incorporation of firm-specific information into stock prices by investigating the impact of financial analysts on the dissemination of disclosed operating lease information.

Accurate safety information in published clinical trials guides the assessment of risk-benefit, as well as the design of future clinical trials. Comprehensive reporting of adverse events, toxicity, and discontinuations from acute spinal cord injury clinical trials is an essential step in this process. Here, we sought to assess the degree of "satisfactoriness" of reporting in past clinical trials in spinal cord injury. A review of citations from MEDLINE and EMBASE identified eligible clinical trials in acute (within 30 days) spinal cord injury. English language studies, published between 1980 and 2020, with sensory, motor, or autonomic neurological assessments as the primary outcome measure were eligible for inclusion. Criteria were then established to qualify the safety reporting as satisfactory (i.e., distinguished severe/life-threatening events), partially satisfactory, or unsatisfactory (i.e., only mentioned in general statements, or reported but without distinguishing severe events). A total of 40 trials were included. Satisfactory reporting for clinical adverse events was observed in 30% of trials; partially satisfactory was achieved by 10% of the trials, and the remaining 60% were unsatisfactory. The majority of trials were determined to be unsatisfactory for the reporting of laboratory-defined toxicity (82.5%); only 17.5% were satisfactory. Discontinuations were satisfactorily reported for the majority of trials (80%), with the remaining partially satisfactory (5%) or unsatisfactory (15%). Reporting of safety in clinical trials for acute spinal cord injury is suboptimal. Due to the complexities of acute spinal cord injury (e.g., polytrauma, multiple systems affected), tailored and specific standards for tracking adverse events and safety reporting should be established.

PurposeManagers of defined-benefit (DB) firms have considerable discretion in deriving pension costs and flexibility in cash contributions to pension plans. Pension accruals occur when cash contributions differ from pension costs. The manipulable nature of pension costs and cash contributions allows managers of DB firms to manipulate pension accruals to achieve their desired earnings. We study whether DB firms with earnings management attributes (referred to as suspect DB firms) used more discretionary pension accruals (DPA) than non-suspect DB firms, especially after the passage of Sarbanes-Oxley (SOX).Design/methodology/approachThe authors develop an aggregate measure of DPA to capture overall earnings management in pension accounting. They then employ a multivariate regression model to study whether the suspect DB firms engage in more DPA than non-suspect firms and to assess the impact of SOX on DPA for all DB firms and for suspect DB firms.FindingsThe authors find evidence that suspect firms inflate DPA to achieve their earnings goals and also that all DB firms and the suspect firms use more DPA in the post-SOX era compared to the pre-SOX period. In contrast, they observe no significant difference in real activities earnings management (REM) between suspect and non-suspect firms. In addition, neither the entire sample of DB firms nor the suspect firms display a significant change in REM after SOX.Research limitations/implicationsThe samples in the study are limited to firms with defined pension plans; thus, the findings cannot be generalized to all firms. In addition, as in other empirical studies relying on models to estimate earnings management proxies, this study inherits estimation errors from Jones and Roychowdhury's models. Consequently, the impact of these estimation errors cannot be ruled out.Practical implicationsThe empirical findings of the study appear that instead of deterring DB firms from engaging in pension accruals earnings management, enacting the stringent anti-fraud SOX prompts these firms to rely more on accrual-based discretionary pension rather than switch to real activities manipulation to manage earnings.Originality/valueWhile many prior studies focus on the impact of managing individual pension assumptions on earnings, the authors study overall earnings management in pension accounting by developing a model to derive an aggregate measure of pension earnings management.

Human neural stem cell transplantation (HuCNS-SC®) is a promising central nervous system (CNS) tissue repair strategy in patients with stable neurological deficits from chronic spinal cord...

Introduction: Major histocompatibility (MHC) class II deficiency is a rare autosomal recessive primary immunodeficiency with fewer than 200 patients reported worldwide. Patients usually present within their first year of life with severe and recurrent infections, failure to thrive, and chronic diarrhea. The disorder is caused by absent or reduced MHC class II expression on cell surfaces, leading to defective cellular and humoral immune responses. The disease is associated with a poor prognosis, with most patients dying in early childhood due to infectious complications. Aim: To report the clinical, immunological, and genetic features of an adult patient with MHC class II deficiency who did not undergo hematopoietic stem cell transplant (HSCT). We also explore proposed theories as to why some patients with MHC class II deficiency survive to adulthood, beyond the typical life expectancy. Results: We present a 23-year-old gentleman who was diagnosed with MHC class II deficiency at the age of 6 months based on a near complete absence of Human Leukocyte Antigen - DR isotype on peripheral blood mononuclear cells and CD4+ lymphopenia. He is one of a few patients with the condition reported in the literature to have survived to adulthood despite not having undergone HSCT. Next generation sequencing revealed a novel homozygous mutation in the CIITA gene, 1 of 4 genes involved in the regulation of MHC class II transcription. Discussion: MHC class II deficiency is considered a single entity phenotypic condition where the main problem lies in reduced or absent MHC class II expression and results in downstream immunologic effects, including CD4+ lymphopenia and impaired antigen specific responses. However, phenotypic differences between patients are emerging as more cases are described in the literature. Our patient, now 23 years old, has survived significantly beyond life expectancy despite not having HSCT. Statement of novelty: We describe a case of an adult patient diagnosed with MHC class II deficiency due to a novel homozygous intronic splice site variant in the CIITA gene.

Background Postbariatric hypoglycemia (PBH) can be a devastating complication for which current therapies are often incompletely effective. More information is needed regarding frequency, incidence, and risk factors for PBH. Objectives To examine hypoglycemia symptoms following Roux-en-Y gastric bypass (RYGB) and laparoscopic adjustable gastric banding (LAGB) and baseline and in-study risk factors. Setting Multicenter, at 10 US hospitals in 6 geographically diverse clinical centers. Methods A prospective, longitudinal cohort study of adults undergoing RYGB or LAGB as part of clinical care between 2006 and 2009 were recruited and followed until January 31, 2015, with baseline and annual postoperative research assessments. We analyzed baseline prevalence and post-operative incidence and frequency of self-reported hypoglycemia symptoms as well as potential preoperative risk factors. Results In all groups, postoperative prevalence of hypoglycemia symptoms was 38.5%. Symptom prevalence increased postoperatively from 2.8%–36.4% after RYGB in patients without preoperative diabetes (T2D), with similar patterns in prediabetes (4.9%–29.1%). Individuals with T2D had higher baseline hypoglycemia symptoms (28.9%), increasing after RYGB (57.9%). Hypoglycemia symptoms were lower after LAGB, with 39.1% reported hypoglycemia symptoms at only 1 postoperative visit with few (4.0%) having persistent symptoms at 6 or more annual visits. Timing of symptoms was not restricted to the postprandial state. Symptoms of severe hypoglycemia were reported in 2.6–3.6% after RYGB. The dominant risk factor for postoperative symptoms was preoperative symptoms; additionally, baseline selective serotonin (SSRI) and serotonin-norepinephrine (SNRI) reuptake inhibitor use was also associated with increased risk in multivariable analysis. Weight loss and regain were not related to hypoglycemia symptom reporting. Conclusion Hypoglycemia symptoms increase over time after RYGB, particularly in patients without diabetes. In a small percentage, symptoms can be persistent or severe and require hospitalization. Preoperative hypoglycemia symptoms and SSRI/SNRI use in RYGB patients without diabetes is associated with increased risk of symptoms.

Background. Given individuals with spinal cord injury (SCI) approaching 2 million, viable options for regenerative repair are desperately needed. Human central nervous system stem cells (HuCNS-SC) are self-renewing, multipotent adult stem cells that engraft, migrate, and differentiate in appropriate regions in multiple animal models of injured brain and spinal cord. Preclinical improved SCI locomotor function provided rationale for the first-in-human SCI clinical trial of HuCNS-SC cells. Evidence of feasibility and long-term safety of cell transplantation into damaged human cord is needed to foster translational progression of cellular therapies. Methods. A first-ever, multisite phase I/IIa trial involving surgical transplantation of 20 million HuCNS-SC cells into the thoracic cord in 12 AIS A or B subjects (traumatic, T2-T11 motor-complete, sensory-incomplete), aged 19 to 53 years, demonstrated safety and preliminary efficacy. Six-year follow-up data were collected (sensory thresholds and neuroimaging augmenting clinical assessments). Findings. The study revealed short- and long-term surgical and medical safety (well-tolerated immunosuppression in population susceptible to infections). Preliminary efficacy measures identified 5/12 with reliable sensory improvements. Unfortunately, without thoracic muscles available for manual muscle examination, thoracic motor changes could not be measured. Lower limb motor scores did not change during the study. Cervical cord imaging revealed, no tumor formation or malformation of the lesion area, and secondary supralesional structural changes similar to SCI control subjects. Interpretation. Short- and long-term safety and feasibility support the consideration of cell transplantation for patients with complete and incomplete SCI. This report is an important step to prepare, foster, and maintain the therapeutic development of cell transplantation for human SCI.

Background Data on the clinical and demographic features of Canadian patients with hereditary angioedema (HAE) are lacking. Objective To describe the clinical and demographic features in a large Canadian HAE cohort and compare them with patients with HAE in other countries. Methods An online questionnaire was distributed to the members of 2 Canadian HAE patient groups to collect information on demographics and HAE clinical characteristics. All participants 18 years of age or older with HAE type I or II were eligible. Frequency, location, prodromes, and triggers of HAE attacks, including types of HAE treatment, were characterized. Results Among the 90 participants who completed the online survey, 57% self-identified as having HAE type 1 and 26% HAE type II. The average diagnostic delay was 11 years. In the preceding 6 months, 24% of the participants had no attacks and 35% experienced greater than 5 attacks. The most frequently affected regions of the body were the abdomen (83%), arms orlegs (63%), face (41%), and larynx or throat (41%). Approximately 87% of the participants reported having access to C1 inhibitor at home, and 69% reported using it for long-term prophylaxis. Conclusion Canadian patients with HAE share common clinical characteristics with patients with HAE in other countries. They had a delay in HAE diagnosis and a high burden of disease, as indicated by the high frequency of attacks in the preceding 6 months. This study provides a better understanding of the demographic and clinical characteristics of Canadian patients with HAE.

Developers spend a significant portion of their time searching for solutions and methods online. While numerous tools have been developed to support this exploratory process, in many cases the answers to developers' questions involve trade-offs among multiple valid options and not just a single solution. Through interviews, we discovered that developers express a desire for help with decision-making and understanding trade-offs. Through an analysis of Stack Overflow posts, we observed that many answers describe such trade-offs. These findings suggest that tools designed to help a developer capture information and make decisions about trade-offs can provide crucial benefits for both the developers and others who want to understand their design rationale. In this work, we probe this hypothesis with a prototype system named Unakite that collects, organizes, and keeps track of information about trade-offs and builds a comparison table, which can be saved as a design rationale for later use. Our evaluation results show that Unakite reduces the cost of capturing tradeoff-related information by 45%, and that the resulting comparison table speeds up a subsequent developer's ability to understand the trade-offs by about a factor of three.

Objective: To establish structure, process and outcome indicators to evaluate tissue integrity in Canadians with spinal cord injury or disease (SCI/D) in the first 18 months following inpatient rehabilitation admission. Method: A Working Group comprised of Canadian subject matter experts in the Domain of Tissue Integrity was formed to define the construct of tissue integrity. A literature review was conducted and a Driver diagram produced to identify factors that influence tissue integrity in individuals with SCI/D. Facilitated meetings were conducted to identify and achieve consensus on structure, process and outcome indicators. Rapid cycle testing was used to pilot test proposed indicators for face validity and feasibility within a quality improvement context. Results: The structure indicators are the proportion of patients with SCI/D who have access to a mirror for skin checks and the proportion of patients who have access to patient education on tissue integrity; the process indicator is the proportion of patients who completed daily head-to-toe skin checks; the intermediary outcome indicator is pressure injury (PI) incidence during inpatient rehabilitation; and the final outcome indicator is the proportion of individuals with intact skin at 18 months following rehabilitation admission. Conclusion: The set of indicators established for the Domain of Tissue Integrity are specifically focused on aspects of care that can impact the maintenance of tissue integrity and the prevention of PI and align with current practice guidelines. The implementation and evaluation of these indicators nationally have the potential to improve care for Canadians with SCI/D.

STUDY DESIGN: Narrative review by individuals experienced in the recruitment of participants to neurotherapeutic clinical trials in spinal cord injury (SCI). OBJECTIVES: To identify key problems of recruitment and explore potential approaches to overcoming them. METHODS: Published quantitative experience with recruitment of large-scale, experimental neurotherapeutic clinical studies targeting central nervous system and using primary outcome assessments validated for SCI over the last 3 decades was summarized. Based on this experience, potential approaches to improving recruitment were elicited from the authors. RESULTS: The rate of recruitment has varied between studies, depending on protocol design and other factors, but particularly inclusion/exclusion criteria. The recruitment rate also ranged over an order of magnitude between individual centers in a given study. In older multicenter studies, average recruitment rate was approximately one person per study center per month. More recent trials experienced lower rates of recruitment and potential reasons for this trend were examined. The current roles and potential of various stakeholder organizations in addressing problems of recruitment were explored. In addition, recent developments in methodology may help reduce the number of subjects required for well-powered studies. CONCLUSIONS: Several approaches are emerging to improve clinical trial design, efficacy outcome measures, and quantifiable surrogate markers, all of which should reduce the number of participants required for adequate statistical power. There is a growing sense of cooperation between various stakeholders but more should be done to bring together consumer and provider groups to improve recruitment and the effectiveness and relevance of neurotherapeutic clinical trials.

This report documents the first-in-man investigational trial and long-term follow-up of HuCNS-SC transplantation in chronic SCI. The small study size and open-label design reflect the pilot nature of this investigation, and the focus on determining feasibility, safety and preliminary efficacy. Based on the short- and long-term safety profile established in this study for individuals with thoracic SCI, a larger-scale, randomized, study in people with cervical SCI was approved in the US. These trials have established that the human spinal cord is a promising target for neural stem cell transplantation.

Background: Given the large number of individuals living with disabling sensorimotor impairment due to spinal cord injury (SCI) approaching 2 million, viable options for regenerative repair strategies of the injured spinal cord are desperately needed. Human central nervous system stem cells (HuCNS-SC®) are self-renewing, multi-potent adult stem cells exhibiting successful engraftment, migration, and region-appropriate differentiation as demonstrated in multiple animal models for the injured brain and spinal cord. In preclinical SCI models, improved locomotor function provided the rationale for the first human thoracic SCI clinical trial of HuCNS-SC cells. Methods: Safety and preliminary efficacy data were collected within a first ever multi-site phase I/IIa trial involving surgical transplantation of 20 million HuCNS-SC cells into the thoracic cord in 12 subjects with sensory or motor complete traumatic paraplegia. Up to 6 years follow-up data was collected applying an extended protocol design augmenting clinical assessments through corroborating measures of sensory thresholds and neuroimaging to improve readouts of safety and efficacy. Findings: The study revealed promising short and long term surgical and medical safety. Measures of preliminary efficacy could discern responders (5/12 patients) with reliable improvements in sensory function albeit without measurable motor changes in thoracic injuries. Imaging of the spinal cord at and rostral the site of injection revealed dynamic structural changes similar to findings in non-transplanted SCI subjects. Interpretation: Findings of safety and feasibility supported the regulatory approval for a Phase II HuCNS-SC transplantation study in cervical spinal cord injured patients. Funding: The initial study (short term follow-up of the first year; STFU) and part of the second study (long term follow-up; LTFU) was funded by Stem Cells Inc, Newark, California, USA. After dissolution of Stem Cells Inc. Q3 2016 grants from Wings for Life (WfL), and the Bright Oceans Corporation (BOCO) enabled completion of the LTFU, compilation of the full set of monitored data (initial Phase I/IIa STFU trial and LTFU study), data analysis and manuscript completion. Declaration of Interest: Armin Curt has no competing interests. Principal Investigator for multi-site Phase I/IIa trial of 12 subjects and primary author (corresponding author). Jane Hsieh, with no competing interests, is an independent consultant to the Spinal Cord Injury Center Balgrist initiating data analysis and the first draft of the manuscript, as well as coordinating contributions from collaborating authors. Martin Schubert with no competing interests, participated in care of 9 enrolled subjects, data analysis and review of manuscript. Markus Hupp has no competing interests. Participated in the care of 9 enrolled subjects and reviewed the manuscript. Susi Friedl has no competing interests. Participated in the care of 9 enrolled subjects and reviewed the manuscript. Patrick Freund has no competing interests. Collected and analyzed neuroimaging data for 9 enrolled subjects and reviewed the manuscript. Eveline Huber has no competing interests. Collected and analyzed neuroimaging data for 9 enrolled subjects and reviewed the manuscript. Dario Pfyffer has no competing interests. Collected and analyzed neuroimaging data for 9 enrolled subjects, assisted with figure creation and reviewed the manuscript. Safety of neural stem cell transplantation into the human spinal cord Draft version: V6.1 20190128 Reto Sutter has no competing interests. Collected and analysed neuroimaging data for 9 enrolled subjects and reviewed the manuscript. Catherine Jutzeler has no competing interests. Collected and analysed electrophysiological data for 9 enrolled subjects and reviewed the manuscript. Rudolf P. Wuthrich has no competing interests. Provided immunosuppression for 9 enrolled subjects and reviewed the manuscript. Kan Min has no competing conflicts of interest. Performed orthopaedic spinal surgery for 9 HuCNS-SC transplantations at Balgrist site and reviewed the manuscript. Steve Casha has no competing interests. Site investigator at University of Calgary with 2 patients enrolled and transplanted, and reviewed the manuscript. Michael Fehlings has no competing interests. Site investigator at University of Toronto with 1 patient enrolled and transplanted, and reviewed the manuscript. Raphael Guzmann has no competing interests. Performed neurosurgery and HuCNS-SC transplantation for 9 enrolled subjects and reviewed the manuscript. Ethical Approval: The study protocol and all amendments were approved by related Ethics Committees and regulatory agencies in accordance with the Declaration of Helsinki.

Hereditary angioedema (HAE) is associated with decreased quality of life (QoL), which has typically been measured using a generic non-disease-specific questionnaire.We aimed to assess the QoL in patients with HAE type I and II in Canada using a previously validated HAE-specific questionnaire.An online questionnaire was sent to the members of two Canadian HAE patient groups to collect data on demographics, HAE clinical course, and QoL scores. All patients 18 years of age or older with HAE type I or II were eligible. The impact of the available clinical factors on the QoL scores was evaluated. Multiple linear regression was performed using clinically relevant factors to predict HAE QoL outcome.Among the 72 patients in the study, the mean total HAE QoL score was 102 (±23) (SD) on a scale of 25 to 135, with higher scores indicating better QoL. Although the total QoL scores correlated positively with patients' level of satisfaction and perceived control (P.001 for both), it correlated negatively with the number of acute attacks (P = .03). Yet, the types of treatment did not have an impact on the QoL. Predictors, including sex, comorbidities, and the number of attacks, only explained 12% of the variance in the total QoL scores.HAE continues to impair QoL in Canadian patients despite receiving recommended treatment. Although the frequency of attacks affects QoL, patients' experience with their HAE care also affects QoL substantially. The study highlights the importance of considering patients' experience with their HAE care as physicians develop an appropriate management plan.

We use ex ante measures of cost of equity to examine: 1) whether the market assimilates off-balance sheet pension liabilities in assessing cost of equity, 2) whether off-balance sheet pension liabilities explain cost of equity in a similar manner as those reported on the balance sheet, and 3) the incremental explanatory power of Statement of Financial Accounting Standards (SFAS) 158 (FASB 2006) on cost of equity. We find that off-balance sheet pension liabilities are significantly positively associated with ex ante cost of equity in the pre- and post-SFAS 158 periods, suggesting that investors incorporate off-balance sheet pension liabilities in assessing cost of equity. However, recognized pension liabilities are more associated with cost of equity than off-balance sheet pension liabilities in both pre- and post-SFAS 158 periods. Furthermore, we find that the implementation of SFAS 158 significantly increases the explanatory power of previously disclosed pension liabilities (e.g., unrecognized prior service costs) on cost of equity, suggesting that SFAS 158 is effective in improving the cost-of-equity implications of pension liabilities.

Background: Spasticity is a common secondary complication of spinal cord injury (SCI), which can severely impact functional independence and quality of life. 4-Aminopyridine (4-AP) is a potassium channel blocker that has been studied as an intervention for spasticity in individuals with SCI. Objective: To conduct a systematic review of the available evidence regarding the effectiveness of 4-AP for the management of spasticity in individuals with SCI. Methods: A comprehensive literature search was conducted on five electronic databases for articles published in English up to January 2017. Studies were included if (1) the sample size was three or more subjects, (2) the population was ≥50% SCI, (3) the subjects were ≥18 years old, (4) the treatment was 4-AP via any route, and (5) spasticity was assessed before and after the intervention. Subject characteristics, study design, intervention protocol, assessment methods, side effects, adverse events, and outcomes were extracted from selected studies. Randomized controlled trials (RCTs) were evaluated for methodological quality using the Physiotherapy Evidence Database (PEDro) tool. Levels of evidence were assigned using a modified Sackett scale. Results: Nine studies met inclusion criteria with a pooled sample size of 591 subjects. Six studies were RCTs (PEDro = 6-10, Level 1 evidence) and three studies were pre-post tests (Level 4 evidence). There was a wide range in duration, severity, and level of SCI across subjects. Oral 4-AP was investigated in five studies; one study reported significant improvements on the Ashworth Scale (AS), while the remaining four studies found no improvement. Three studies found no significant improvements on the Spasm Frequency Scale. Intravenous 4-AP was investigated in three studies; no significant improvements were found on the AS or in the Reflex Score. Intrathecal 4-AP was investigated in one study, which did not find significant improvements on the AS. Conclusion: There is weak evidence supporting the effectiveness of 4-AP in reducing spasticity post SCI. Future research should utilize contemporary measures of spasticity and address methodological limitations such as small sample sizes.

Programmers consistently engage in cognitively demanding tasks such as sense making and decision-making. During the information-foraging process, programmers are growing more reliant on resources available online since they contain masses of crowdsourced information and are easier to navigate. Content available in questions and answers on Stack Overflow presents a unique platform for studying the types of problems encountered in programming and possible solutions. In addition to classifying these questions, we introduce possible visual representations for organizing the gathered information and propose that such models may help reduce the cost of navigating, understanding and choosing solution alternatives.

We observe a substantial earnings impact from capitalizing the operating leases for firms on Compustat over 1996–2010. This earnings impact is derived from the disclosed lease information and is similar to the earnings difference that arises from applying the accelerated versus the straight-line model, two alternative models proposed by the Financial Accounting Standards Board and the International Accounting Standards Board (the Boards) in 2013 to account for lease expense for lessees. Our focus is on the economic implications of this earnings impact. Applying a one-year cash flow prediction model, we observe a significant relationship between the negative impact and future operating cash flows. Using a return-earnings model, we find that both negative and positive impacts possess an incremental explanatory power for contemporaneous stock returns beyond reported earnings. Our findings provide timely empirical evidence for the Boards to evaluate two alternative models for lessees' expenses as they are in the midst of redeliberations of accounting for leases.

In response to criticisms of U.S. pension accounting standards, the Financial Accounting Standards Board (FASB) issued Statement of Financial Accounting Standards 158 in 2006. However, the authors say more needs to be done, and they propose a gross recognition approach in which gross pension assets and liabilities are reported and prior service costs and actuarial gains/losses are recognized as they are incurred. An implication is that auditors should apply the same auditing standards to disclosed pension information as to recognized information, and regulators should consider moving pension information to the statements to improve reliability.

Background Human central nervous system stem cells (HuCNS-SC) are multipotent adult stem cells with successful engraftment, migration, and region-appropriate differentiation after spinal cord injury (SCI). Objective To present data on the surgical safety profile and feasibility of multiple intramedullary perilesional injections of HuCNS-SC after SCI. Methods Intramedullary free-hand (manual) transplantation of HuCNS-SC cells was performed in subjects with thoracic (n = 12) and cervical (n = 17) complete and sensory incomplete chronic traumatic SCI. Results Intramedullary stem cell transplantation needle times in the thoracic cohort (20 M HuCNS-SC) were 19:30 min and total injection time was 42:15 min. The cervical cohort I (n = 6), demonstrated that escalating doses of HuCNS-SC up to 40 M range were well tolerated. In cohort II (40 M, n = 11), the intramedullary stem cell transplantation needle times and total injection time was 26:05 ± 1:08 and 58:14 ± 4:06 min, respectively. In the first year after injection, there were 4 serious adverse events in 4 of the 12 thoracic subjects and 15 serious adverse events in 9 of the 17 cervical patients. No safety concerns were considered related to the cells or the manual intramedullary injection. Cervical magnetic resonance images demonstrated mild increased T2 signal change in 8 of 17 transplanted subjects without motor decrements or emerging neuropathic pain. All T2 signal change resolved by 6 to 12 mo post-transplant. Conclusion A total cell dose of 20 M cells via 4 and up to 40 M cells via 8 perilesional intramedullary injections after thoracic and cervical SCI respectively proved safe and feasible using a manual injection technique.

To examine the effectiveness of botulinum toxin type A (BTX-A) on neurogenic detrusor overactivity (NDO) in individuals with spinal cord injury (SCI).MEDLINE, CINAHL, EMBASE, and PsycINFO databases were searched for all relevant articles published from 1980 to June 2012.Trials examining the use of BTX-A injections into the detrusor wall in the treatment of NDO after SCI were included if (1) ≥ 50% of study sample comprised subjects post-SCI; (2) outcomes of interest were assessed before and after treatment with a single injection of BTX-A; and (3) the sample size was ≥ 3.A standardized mean difference ± SE (95% confidence interval) was calculated for at least 1 of the following outcomes in every study: postvoid residual urine volume, reflex detrusor volume, bladder capacity, bladder compliance, catheterization frequency, and maximum flow rate. Results from all studies were then pooled using a random-effects model. Treatment effect sizes were interpreted as small,0.2; moderate,0.5; or large,0.8.Fourteen studies representing data from 734 subjects were included. After BTX-A injection, large treatment effects were observed in postvoid residual urine volume, reflex detrusor volume, bladder capacity, bladder compliance, and catheterization frequency (P.01). Rate of incontinence episodes was reduced from 23% to 1.31% after BTX-A treatment. No significant decrease in max flow rate was observed (P=.403).Results of the meta-analysis indicate BTX-A is effective in treating NDO after SCI. The use of BTX-A was associated with a decrease in incontinence episodes, catheter use, and bladder pressures.

Objective To assess the adequacy of image agreement regarding uveitis based on color fundus and fluorescein angiography images alone, and to use free and open source applications to conduct an image agreement study. Design Cross-sectional agreement study. Participants Baseline fundus and fluorescein images of patients with panuveitis, posterior, or intermediate uveitis enrolled in the Multi-center Uveitis Steroid Treatment (MUST) trial. Methods Three fellowship-trained specialists in uveitis independently reviewed patient images using ClearCanvas™ and responded using Epi Info™. The diagnoses of the 3 reviewers were compared with the MUST clinician as a gold standard. A rank transformation adjusted for the possible variation in number of responses per patient. Chance-corrected interobserver agreement among the 3 reviewers was estimated with the ι coefficient. Confidence interval (CI) and SE were bootstrapped. Results Agreement between the diagnoses of the respondents and the baseline MUST clinician’s diagnosis was poor across all diagnostic categories, ι = 0.09 (95% CI, 0.07–0.11). The agreement among respondents alone also was poor, ι = 0.11 ± 0.02 (95% CI, 0.08–0.13). The specialists requested more patient historical and clinical information to make a diagnosis on all patients. Conclusions The role in distinguishing the multiple conditions in uveitis appears to be limited when based on fundus imaging alone. Future studies should investigate different categories of clinical data to supplement image data. Freely available applications have excellent utility in ophthalmic imaging agreement studies.

This case illustrates the effects of the proposed new lease standard by the Financial Accounting Standards Board and the International Accounting Standards Board on existing outstanding operating leases. Specifically, the case examines the effects of the proposal that all firms report existing operating leases as capital leases upon the initial adoption of the proposed standard. By applying a constructive capitalization model to two firms who rely on operating leases for financing, FedEx and UPS, we found that both companies would have to record billions of dollars of liabilities that had only appeared in the footnotes of their financial statements under the current lease standards. In addition, the firms would experience a decline in retained earnings and key financial ratios, such as the debt-to-equity, return-on-assets, and interest coverage ratios, by reporting operating leases as capital leases under the new proposed standard. Furthermore, the magnitude of the lease capitalization impact is much smaller for UPS than for FedEx.

Mehta S, Hill D, Foley N, Hsieh J, Ethans K, Potter P, Baverstock R, Teasell RW, Wolfe D, the Spinal Cord Injury Rehabilitation Evidence Research Team. A meta-analysis of botulinum toxin sphincteric injections in the treatment of incomplete voiding after spinal cord injury. Objective To conduct a systematic review and meta-analysis to examine the effect of injecting botulinum toxin A (BTX-A) into the detrusor sphincter on improving bladder emptying in individuals with spinal cord injury (SCI). Data Sources MEDLINE, CINAHL, EMBASE, and PsycINFO databases were searched for all relevant articles published from 1980 to September 2011. Data Selection All trials examining the use of BTX-A injections into the detrusor sphincter for the treatment for incomplete bladder emptying after SCI were included if at least 50% of the study sample comprised subjects with SCI, and if the SCI sample size was 3 or greater. Data Extraction A standardized mean difference (SMD) ± SE and 95% confidence interval (CI) were calculated for each outcome of interest, and the results were pooled using a fixed or random effects model, as appropriate. Outcomes assessed included postvoid residual urine volume (PRV), detrusor pressure (PDet), and urethral pressure (UP). Effect sizes were interpreted as small, 0.2; moderate, 0.5; and large, 0.8. Data Synthesis A relatively limited number of studies (2 randomized controlled trials, 6 uncontrolled trials) were identified. The 8 studies included results from 129 subjects. There was a statistically significant decrease in PRV at 1 month (SMD=1.119±.140; 95% CI, .844–1.394; P P =.009); pooled PDet decreased from 88.7 to 20.5cmH 2 O. A large statistical effect size on UP (SMD=.896±.291; 95% CI, .327–1.466; P =.002) and an improvement from 119.7 to 102.3cmH 2 O were seen. The systematic review also indicated a 50% reduction in urinary tract infections based on 3 studies. Discontinuation or reduction in catheter usage was reported in 4 studies after BTX-A. Conclusions Results of the meta-analysis indicate that BTX-A is effective in reducing PRV and demonstrating a statistically significant reduction in PDet and UP 1 month postinjection. However, the clinical utility of BTX-A is yet to be determined.

Although research in the field of spinal cord injury (SCI) is a relatively new endeavor, a remarkable number of papers focused on this subspecialty have been published in a broad variety of journals over the last two decades. A multidisciplinary group of experts, including clinical epidemiologists, neurosurgical and orthopedic spine surgeons, basic scientists, rehabilitation specialists, intensivists, and allied health professionals (nursing and physical therapy) was assembled through the Spinal Cord Injury Solutions Network to summarize the existing literature focusing on 12 key topics related to acute traumatic SCI, which have not been recently reviewed. The objective was to develop evidence-based recommendations to help translate current science into clinical practice and to identify new directions for research. For each topic one to three specific questions were formulated by consensus through the expert panel. A systematic review of the literature was performed to determine the current evidence for the specific questions. A primary literature search was performed using MEDLINE, CINAHL, EMBASE, and Cochrane databases. A secondary search strategy incorporated additional articles referenced in significant publications (i.e., meta-analysis, systematic and nonsystematic review articles). Two reviewers independently reviewed the titles and abstracts yielded by this comprehensive search and subsequently selected articles based on the predetermined inclusion and inclusion criteria. Data were extracted for population into evidentiary tables. Selected articles were rated for level of evidence and methodological quality, information that was also included in evidentiary tables. Disagreements were resolved by a third reviewer or consensus-based discussion. Based on the evidence compiled, answers to the targeted questions were formulated and recommendations generated by consensus-based discussion and anonymized voting using Delphi methodology. A level of consensus of 80% or higher was considered to represent strong agreement.

In this paper, an algorithm using binary trees is developed to detect the change points of a data set in which the data are assumed to be normally distributed. Usual BIC-type criteria are considered in the binary searching procedures when the number of change points is unknown. The algorithm is also extended to the switching regression models. Simulation study confirms that our algorithm is efficient compared with the ML-method. A real data example also verifies that the proposed procedure is appropriate.

Applying constructive lease capitalization to operating leases of firms in the 2003 S&P 500 index, we demonstrate that currently companies can hide billions of liabilities, enhance retained earnings, income, and ratios by reporting leases as operating. With the rekindled interests of the International Accounting Standards Board and Financial Accounting Standards Board on lease reporting, our study provides valuable and timely information for their decisions. Results indicate that by reporting operating leases, firms avoided on average $582 million of liabilities (11% of total liabilities) and $450 million of assets (4% of total assets) for our 366 sample firms. Partitioning sample into negative and positive income impact subgroups provides additional insight into firm's motivation for using operating leases. Under lease capitalization the top quartile positive subgroup experienced an 18% increase in income while the top quartile negative subgroup had an 11% decline in income. There was also a significant negative impact on liquidity, leverage and performance ratios.

Purpose – The purpose of this paper is to examine whether the choice of accounting treatment of transition obligation under SFAS 106 affects the value of firms, and also whether the quality of earnings is improved after the implementation of SFAS 106.Design/methodology/approach – Different regression models were employed on a sample of 50 immediate recognition firms and 50 matched prospective recognition firms. Chow test is also used to investigate the quality of earnings before and after the implementation of SFAS 106.Findings – In spite of the significant difference in impact on earnings from the choice of treatment of transition obligation, the accounting choice has no significant impact on the total value relevance of earnings and book value. When immediate recognition method is applied, investors ignore the one‐time charge of transition obligation, and rely more on book value in the valuation of a firm. However, when prospective recognition method is applied, both earnings and book value are value‐re...

Modern spinal cord injury (SCI) care is purported to involve treatment in specialized centers with an interdisciplinary team of health care professionals providing care as early as possible following injury. Care is delivered throughout the rehabilitation process with appropriate discharge to the community characterized by ongoing outpatient care and follow-up. This article is intended to describe the evidence that exists for aspects of this model of SCI care. Specifically, we examined the evidence for specialized versus general care, early versus late hospital admission, and follow-up care. A second objective of the article is to describe relevant findings of the most common outcomes within the rehabilitation context. We have summarized the outcomes of length of stay, neurological status, and functional status over the rehabilitation stay and examined the interrelationships among these outcomes.

Here's an important leasing strategy that CEOs, CFOs, and treasurers should know about. By applying constructive lease capitalization on the operating leases of several firms, the authors show that companies can hide many liabilities from financial reporting. And they can also enhance net income, retained earnings, and key financial ratios —all by reporting leases as operating leases instead of capital leases. © 2006 Wiley Periodicals, Inc.

This study examines the value relevance of reported earnings and book value under pooling-of-interests and purchase accounting. Using a sample of 110 merger or acquisition transactions from the period 1988 to 1996, the value relevance of the two accounting approaches is investigated by examining the correlation of post-merger earnings and book value with share price. Regression analysis using Ohlson's (1995) valuation model is conducted for the merger year (m) and the subsequent year ( m + 1 ) using three samples (pooling only, purchase only and a combined sample). The results are as follows: • When pooling accounting is used, only earnings are value relevant, and the results are consistent with earnings under pooling being more value relevant than book value. • When purchase accounting is used, both earnings and book value are value relevant and no significant difference was found between the value relevance of earnings and book value. • A Vuong test indicates that the adjusted R2 of the valuation model under purchase accounting significantly exceeds that under pooling for the merger year only for the combined sample. Thus, this result provides weak evidence that the earnings and book value under purchase accounting better explain firm value than those under pooling. • The relative value relevance of earnings and book value under the two methods is pooling earnings>purchase earnings and purchase book value>pooling book value. • Using proxy variables for earnings and book value reflecting the consolidation framework of Statement of Financial Accounting Standards (SFAS) Nos. 141 and 142, the results indicate that the proxy variables yield earnings and book value data that better explain firm value than those produced using either pooling accounting or purchase accounting for half of the testing periods and sample groups. Thus, our results provide some evidence to support the FASB's decision to eliminate pooling accounting.

O This study explored the use of visualization as a study strategy for middle school science concept learning when compared to unguided study. In addition, the differential impact of visualization training for different cultural groups was addressed. Data collected in school settings were analyzed quantitatively and qualitatively. The results showed that the 8thgrade Texan and Taiwanese students who attended visualization workshops and constructed visualizations during study time scored significantly higher on a comprehension posttest than those students who applied an unguided study strategy. Overall, Taiwanese students scored higher than Texan students, but there was no interaction between the type of treatment and cultural background.

The advanced motion vector prediction (AMVP) used in the newly developed High Efficiency Video Coding (HEVC) employs five MV candidates from both spatial and temporal domains for merge mode decision. The merge index is then entropy coded using a simple prefix code. To reduce merge index overhead, in this paper we propose a new merge mode decision algorithm which suggests using decoder derived MV candidates for merge mode decision, based upon both sum of absolute bidirectional prediction differences (SABPD) and template matching (TM) criteria. As a result, only a merge index flag is required for transmission instead of prefix coded index. The experimental results reveal that the proposed algorithm achieves up to 1.46% of bit rate reduction (with average 0.73% reduction), compared to the method used in the HEVC.

To review the available evidence on the effectiveness of intrathecal baclofen in the treatment of spasticity in individuals with spinal cord injuries (SCIs) at least 6 months post-injury or diagnosis.A literature search of multiple databases (Pub Med, CINAHL, EMBASE) was conducted to identify articles published in the English language.Studies were included for review if: (1) more than 50% of the sample size had suffered a traumatic or non-traumatic SCI; (2) there were more than three subjects; (3) subjects received continuous intrathecal baclofen via an implantable pump aimed at improving spasticity; and (4) all subjects were ≥6 months post-SCI, at the time of the intervention.Data extracted from the studies included patient and treatment characteristics, study design, method of assessment, and outcomes of the intervention.Methodological quality was assessed using the PEDro for randomized-controlled trials (RCTs) and the Downs and Black (DB) tool for non-RCTs. A level of evidence was assigned to each intervention using a modified Sackett scale.The literature search resulted in 677 articles. No RCTs and eight non-RCTs (DB scores 13-24) met criteria for inclusion, providing a pooled sample size of 162 individuals. There was substantial level 4 evidence that intrathecal baclofen is effective in reducing spasticity. Mean Ashworth scores reduced from 3.1-4.5 at baseline to 1.0-2.0 (P0.005) at follow-up (range 2-41 months). Average dosing increased from 57-187 µg/day at baseline to 218.7-535.9 µg/day at follow-up. Several complications from the use of intrathecal baclofen or pump and catheter malfunction were reported.

We investigate value relevance of the earnings impact of the Statement of Financial Accounting Standards No. 13 (SFAS 13). SFAS 13 requires committed long-term leases to be capitalized as assets and liabilities along with recognition of depreciation expense and interest charges. This requirement tends to have adverse effects on risk, debt ratios, and earnings numbers. Previous research finds significance of capital lease information through its impact on risk and debt ratios from a balance sheet statement perspective. Unlike previous studies, we evaluate the value relevance of SFAS 13 from an income statement prospective. SFAS 13 requires a restatement of prior year's income for the SFAS 13 effect when adopting the standard. Thus, we measure earnings impact of SFAS 13 for the year (t) prior to the adoption as the difference between the restated earnings minus the reported earnings of year t. The earnings impact of SFAS 13 can be reasonably inferred from the footnote disclosure in year t due to the disclosure requirement of Accounting Series Report No. 147. Based on the efficient market hypothesis, the disclosed earnings impact of SFAS 13 of year t should be reflected in the stock price of year t. We employ a return-earnings model to investigate whether the market participants incorporate earnings impact of SFAS 13 in the assessment of market value of firms. We do not find significant value relevance for the earnings impact of SFAS 13 using the traditional linear model. However, we find evidence supporting value relevance for the earnings impact of SFAS 13 using nonlinear models but only when the earnings impact is large. In addition, based on a rank-adjusted earnings model developed in this paper, we find that the earnings impact of SFAS 13 has larger value relevance than do the pre-SFAS No. 13 earnings. While our main objective is to evaluate the value-relevance of earnings caused by SFAS 13, our paper also contributes to an extensive investigation of the performance of different return-earnings models and to the development of a rank-adjusted earnings model.

We examine (1) whether there is a shift in beta for individual securities around quarterly earnings announcements, and (2) whether these beta changes relate to certain characteristics of the firms. We find a statistically significant upward (downward) beta shift during the two-day earnings announcement period for 25 per cent (9 per cent) of a sample of 195 US firms. We also find that the beta shift at the time of the earnings announcement is significantly higher for small firms (i.e., more precise announcements).

This phenomenologic study intended to explore the meaning of caring in Taiwanese culture. With 285 informants, the research was completed using open questions during an interviewing process. Using Van Kaam’s phenomenologic method for content analysis, the following categories related to caring were explored: psychosocial domain (unconditional acceptance, empathy, genuineness, respect and treating others as family members), caring action domain (providing professional behaviors, fulfilling needs, sensational approaching, self offering, supporting, and providing a suitable environment), motivation (caring provider’s situation, receiver’s needs, reinforcing factors, and restraining factors), and provider’s and receiver’s caring responses. Relationships between categories were incorporated into a dynamic caring model.

This paper examines the factors associated with the timing of overfunded pension plan termination.

Traumatic injury as a trigger for the subsequent development of psoriatic arthritis (PsA) has been implicated by several case reports and case series. However, it is still unclear whether trauma is the inciting event or just an incidental finding. It is thought that the interplay of genetic, immunologic, and environmental factors, such as trauma, may trigger the development of PsA. At least two hypotheses of how trauma may be linked to the development of PsA have surfaced and involve a "deep Koebner effect," the concept of a synovio-entheseal complex and activation of the innate immune system by biomechanical factors. The role of neuropeptides such as substance P and vasoactive intestinal peptide has been highlighted in the synovium after trauma. Better understanding of this phenomenon would shed light into the pathophysiology of Psa and help the development of preventive and therapeutic strategies.

This paper proposes an encoding-assisted temporal DIRECT mode decision algorithm for H.264/AVC inter bi- predictive (B) frame video sequences to improve the coding efficiency. In the proposed algorithm, we employ motion vectors (MVs) of co-located block and its eight neighboring blocks for DIRECT mode decision. In addition, the weight selection for bidirectional prediction is also considered. The best MV and weight to minimize the sum of absolute prediction error is selected for DIRECT mode decision. The experimental results reveal that the proposed algorithm achieves average 0.1 dB PSNR gain or equivalently average 1.6% bit-rate reduction, compared to the conventional DIRECT mode coding that only uses the MV of the co-located MB for DIRECT mode decision.

In this paper., we propose an efficient temporal DIRECT mode decision algorithm for H.264/AVC inter bi-predictive (B) frame video coding to improve the coding efficiency. In the suggested technique, in addition to the motion vector (MV) of the co-located block we also employ MVs of eight neighboring blocks for DIRECT mode decision. The best MV is selected for DIRECT mode decision based upon the sum of absolute bidirectional prediction differences (SABPD) criterion. No extra overhead is required in the proposed algorithm. The experimental results reveal that the proposed algorithm achieves average 0.16 dB PSNR gain or equivalently average 3.34% bit-rate saving, compared to the conventional DIRECT mode coding that only uses the MV of the co-located MB for DIRECT mode decision.

Patients present with recurrent, pruritic, wheal-and-flare lesions that fade within 24 hours without scarring.[1][1] The condition can occur with angioedema in 30%–50% of patients and should be differentiated from acute urticaria (lasting < 6 weeks) and physically induced urticaria (e.g., by cold

A modified Bayesian decision model is derived in the study to systematically estimate an optimal cutoff point for bankruptcy prediction models. In addition, a loss function is implemented in the model so that the total error costs instead of the total error probability is minimized. Any dichotomous classification problem with unequal error costs would find this decision model useful.

In summary, we delivered a visualization workshop designed to help learners use computer graphics to construct meaning while they study. When delivering visualization workshops in the natural setting of schools, problems are bound to arise. Technical failure, human interruptions, lack of active participation, limited access, distraction by alternate tools or games on computers, and differences in learners’ abilities each affect the success of a workshop. Middle schoolers are unsophisticated learners and require guidance toward effective visualization. In our workshop, in spite of problems associated with the natural setting of a school, students engaged actively in the meaning-making process of studying while we provided scaffolding. Students who successfully formulated mental representations of concepts and then concretized those representations as computer graphics applied a strategy for spending time thinking in order to learn.

In the previous work [8], we suggest a zero-block inter/intra mode decision algorithm for H.264/AVC video coding based upon the number of zero-blocks of 4x4 DCT coefficients between the current macroblock (MB) and the co-located macroblock (MB) (i.e., using zero motion vector (MV)). The proposed algorithm can achieve significant improvement in computation, while maintaining high-coding efficiency. In this paper, we improve its computation to a great extent using the prediction MVs to compute the number of 4×4 zeroblocks, instead of zero MV. Experimental result shows that another reduction of 1~3% of total encoding time can be accomplished, while preserving good coding performance compared to the method using zero MV.

Market-return data and a multivariate regression model are used to investigate the impact of the Omnibus Budget Reconciliation Act of 1987 (OBRA) on the wealth of shareholders of firms sponsoring overfunded and underfunded pension plans during the period surrounding the passage of OBRA. Assuming semistrong market efficiency, a reduction in the pension insurance effect associated with the passage of OBRA was hypothesized to have a negative impact on the security prices of all plan sponsors. In general, the market reacted unfavorably to sponsors of both overfunded and underfunded defined-benefit pension plans when OBRA was introduced. However, the market reaction varied as a function of the funding-level change during the period preceding passage of the Act.

A paucity of information is available on the comparative body composition changes after bariatric procedures. The present study reports on the body mass index (BMI) and body composition changes after 4 procedures by a single group.At the initial consultation, the weight and body composition of the patients undergoing 4 different bariatric procedures were measured by bioimpedance (Tanita 310). Follow-up examinations were performed at 1 year and at subsequent visits after surgery. Analysis of variance was used to compare the postprocedure BMI and body composition. Analysis of covariance was used to adjust for baseline differences.A total of 101 gastric bypass (GB) patients were evaluated at 19.1 + or - 10.6 months, 49 biliopancreatic diversion with the duodenal switch (BPD/DS) patients at 27.5 + or - 16.3 months, 41 adjustable gastric band (AGB) patients at 21.4 + or - 9.2 months, and 30 sleeve gastrectomy (SG) patients at 16.7 + or - 5.6 months (P.0001). No differences were found in patient age or gender among the 4 groups. The mean preoperative BMI was significantly different among the 4 groups (P.0001): 61.4 kg/m(2), 53.2, 46.7, and 44.3 kg/m(2) for the SG, BPD/DS, GB, and AGB group, respectively. The postoperative BMI adjusted for baseline differences was 27.8 (difference 23.6 + or - 8.3), 32.5 (difference 15.6 + or - 5.0), 37.2 (difference 18.2 + or - 8.2), and 39.5 kg/m(2) (difference 7.5 + or - 4.3) for the BPD/DS, GB, SG, and AGB groups, respectively (P.0001). The percentage of excess weight loss was 84%, 70%, 49%, and 38% for the BPD/DS, GB, SG, and AGB groups, respectively (P.0001). The postoperative percentage of body fat adjusted for baseline differences was 25.7% (23.9% + or - 7.0%) 32.7% (16.1% + or - 10.5%) 37.7% (16.7% + or - 5.6%), and 42% (6.0% + or - 6.8%) for the BPD/DS, GB, SG, and AGB groups, respectively (P.0001). The lean body mass changes were reciprocal.Although the BPD/DS procedure reduced the BMI the most effectively and promoted fat loss, all the procedures produced weight loss. The AGB procedure resulted in less body fat loss within 21.5 months than SG within 16.7 months. Longer term observation is indicated.