In China many women in labor are young primigravidas whose fear of labor pain leads them to request cesarean deliveries. While the rate of cesarean deliveries has reached 50% in many hospitals, less than 1% of women in labor are given neuraxial analgesia. The necessary equipment is seldom available in China and many physicians have misconceptions about the risks associated with neuraxial analgesia, which are low with the ultra-low-dosages used today. However, attitudes have begun to change. Meetings held in China have brought together Chinese physicians and world experts on the various epidural and combined spinal-epidural techniques. Thanks to the information and support provided at these meetings clinical trials were carried out, more than 5000 women benefited from labor analgesia, and publications appeared in Chinese journals. An effective, safe, and cost-effective way to provide analgesia to women in labor may slow the increase in cesarean delivery rates across China and improve women's health in general.
M any factors are used to identify women at risk for a cesarean delivery (CS). One factor that has not been analyzed is the ability of obstetric nurses to predict which women will subsequently deliver vaginally or abdominally. A PubMed search found no related articles and the authors undertook this prospective, blinded study to determine if a labor/delivery nurse can identify which parturients they are caring for will undergo a CS.Women Z18 years of age, with singleton gestations at Z37 weeks, were eligible for the study. Women planning a scheduled cesarean section and/or with breech presentations were excluded. Nurses directly involved with the care of each woman made a written prediction of mode of delivery, blinded to the parturient and other care personnel. Predictions were based on maternal age, race, gravidity, parity, body mass index, largest prior delivery if parous, estimated fetal weight, maternal pelvis, and labor progression, all recorded within 1 hour of admission for labor. Participating nurses all had an associate, bachelor, or Master of Science degree. A secondary analysis was used to determine the influence of nurse experience on the likelihood of a correct prediction.Of 2816 candidates, 199 parturients took part in the study; 34 nurses made predictions. The mean maternal age was 25.4 ± 5.2 years, with the majority being white (55%). The mean gestational age was 39.0 ± 1.5 weeks; mean birth weight was 3398 ± 500 g. The mean number of years the nurses had worked in labor and delivery was 8.9 ± 7.1 years; and the majority (92%) had a Bachelor of Science in Nursing degree. Overall, the nurses correctly predicted the route of delivery in 77% of the cohorts (154/199; 95% confidence interval, 71-82). Following an analysis of the sensitivity, specificity, and positive and negative predictive values, the pretest probability of a CS in this study was 29%; the probability of a correct prediction by nursing staff was only 51%. Years of nursing experience did not influence predictive accuracy.The study has some limitations, including the uneven mix of participating nurses' experience, but the authors concluded that overall predictive accuracy for the mode of delivery by nurses directly involved with laboring women was no better than 50/50. They suggested that this study be repeated among midwives and, if the predictive accuracy is high, it could provide another tool for improving risk perception and subsequent assignment to either a low-risk or high-risk intrapartum unit.
This paper examines the issue of earning management in companies with equity incentives from two dimensions: management manipulation of the intensity of R&D and accounting treatment by using a sample of Shanghai and Shenzhen listed companies in China from 2014 to 2019. We find that in order to depress the benchmarks and exercise prices for the performance appraisal of the equity incentive covenants, managers not only conduct accrual earnings management by expensing R&D expenditure but also increase the intensity of R&D investment for real earnings management. We also find that companies with equity incentives where managers have more power are more inclined to opt for the more concealed means of real earnings management and try to avoid accrual earnings management, which may entail higher regulatory costs and greater litigation risk with tightening accounting regulations. Our findings contribute to expanding the literature on earnings management of companies with equity incentives and provide empirical evidence for regulators to implement ‘precision regulation’ on equity incentives and earnings management.
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