Friendships and other rewarding affilliative bonds are associated with the actions of the nonapeptide hormone oxytocin (OT) in humans and many social mammals. We determined if OT itself is rewarding, and if that reward is dependent upon the presence of conspecifics. We evaluated the reinforcing effects of OT infusion in female mice on social (conditioned social preference, CSP), and non-social tests (conditioned place preference, CPP). Ovariectomised females received oestradiol implants and intracerebroventricular cannulas. During a pre-test, they were introduced to a 3-chamber apparatus for 10 minutes. Social and place apparatus were identical, except that each end-chamber contained a novel stimulus female for CSP, whereas they were distinguished by visual and tactile cues for CPP. For CSP, test females received OT (0, 100, 200 or 100ng) and were paired for 30 minutes with one stimulus female. On alternating days, they received saline vehicle and were paired with the opposite female, for a total of 4 pairings each. The final conditioned preference test was identical to the pre-test. OT induced CSP. Test mice that received 100ng OT increased their preference score from −67.4±22.1 seconds in pre-test to +55.7±35.1 seconds during the conditioned preference test (p<0.05). 200ng OT induced an increase in preference score from −162.7±47.3 to +74.3±23.7 seconds (p <0.001). There was no effect of 0 or 1000ng OT on CSP. An additional group of mice was tested for CPP at 200ng OT. Testing and pairings were identical to CSP. OT induced a small but significant CPP. Mice increased their preference score from −222.4±38.0 to −126.0±58.7 seconds (p<0.05). OT had no effect on anxiety or odor recognition as assessed by elevated plus maze and olfactory habituation/dishabituation tests, respectively. In conclusion, OT like other motivating stimuli (drugs, food) is rewarding when tested under solitary conditions, but is also reinforcing in a social setting.
Objectives: The Emergency Medical Treatment and Labor Act (EMTALA) is a federal law enacted in 1986 prohibiting patient dumping (refusing or transferring patients with emergency medical conditions without appropriate stabilization), and discrimination based upon ability to pay. We evaluate hospital-level features associated with citation for EMTALA violation. Materials and Methods: A retrospective analysis of observational data on EMTALA enforcement (2005–2013). Regression analysis evaluates the association between facility-level features and odds of EMTALA citation by hospital-year. Results: Among 4916 EMTALA-obligated hospitals there were 1925 EMTALA citation events at 1413 facilities between 2005 and 2013, with 4.3% of hospitals cited per year. In adjusted analyses, increased odds of EMTALA citations were found at hospitals that were: for-profit [odds ratio (OR): 1.61; 95% confidence interval (CI): 1.32–1.96], in metropolitan areas (OR: 1.32; 95% CI: 1.11–1.57); that admitted a higher proportion of Medicaid patients (OR: 1.01; 95% CI: 1.0–1.01); and were in the top quartiles of hospital size (OR: 1.48; 95% CI: 1.10–1.99) and emergency department (ED) volume (OR: 1.56; 95% CI: 1.14–2.12). Predicted probability of repeat EMTALA citation in the year following initial citation was 17% among for-profit and 11% among other hospital types. Among citation events for patients presenting to the same hospital’s ED, there were 1.30 EMTALA citation events per million ED visits, with 1.04 at private not-for-profit, 1.47 at government-owned, and 2.46 at for-profit hospitals. Conclusions: For-profit ownership is associated with increased odds of EMTALA citations after adjusting for other characteristics. Efforts to improve EMTALA might be considered to protect access to emergency care for vulnerable populations, particularly at large, urban, for-profit hospitals admitting high proportions of Medicaid patients.
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