Differentiating patterns of violence in the family

The feasibility and prevalence of Reciprocal, Hierarchical and Paternal patterns of family aggression hypothesised by Dixon and Browne (2003) were explored within a sample of maltreating families. The psychological reports of 67 families referred to services for alleged child maltreatment that evidenced concurrent physical intimate partner violence and child maltreatment were investigated. Of these, 29 (43.3%) cases were characterised by hierarchical; 28 (41.8%) Reciprocal and 10 (14.9%) Paternal patterns. Significant differences in the form of child maltreatment perpetrated by mothers and fathers and parent dyads living in different patterns were found. In Hierarchical sub-patterns, fathers were significantly more likely to have been convicted for a violent and/or sexual offence than mothers and were significantly less likely to be biologically related to the child. The findings demonstrate the existence of the different patterns in a sample of families involved in the Child Care Protection process in England and Wales, supporting the utility of a holistic approach to understanding aggression in the family

Omecamtiv mecarbil in chronic heart failure with reduced ejection fraction, GALACTIC‐HF: baseline characteristics and comparison with contemporary clinical trials

Aims: The safety and efficacy of the novel selective cardiac myosin activator, omecamtiv mecarbil, in patients with heart failure with reduced ejection fraction (HFrEF) is tested in the Global Approach to Lowering Adverse Cardiac outcomes Through Improving Contractility in Heart Failure (GALACTIC‐HF) trial. Here we describe the baseline characteristics of participants in GALACTIC‐HF and how these compare with other contemporary trials. Methods and Results: Adults with established HFrEF, New York Heart Association functional class (NYHA) ≥ II, EF ≤35%, elevated natriuretic peptides and either current hospitalization for HF or history of hospitalization/ emergency department visit for HF within a year were randomized to either placebo or omecamtiv mecarbil (pharmacokinetic‐guided dosing: 25, 37.5 or 50 mg bid). 8256 patients [male (79%), non‐white (22%), mean age 65 years] were enrolled with a mean EF 27%, ischemic etiology in 54%, NYHA II 53% and III/IV 47%, and median NT‐proBNP 1971 pg/mL. HF therapies at baseline were among the most effectively employed in contemporary HF trials. GALACTIC‐HF randomized patients representative of recent HF registries and trials with substantial numbers of patients also having characteristics understudied in previous trials including more from North America (n = 1386), enrolled as inpatients (n = 2084), systolic blood pressure < 100 mmHg (n = 1127), estimated glomerular filtration rate < 30 mL/min/1.73 m2 (n = 528), and treated with sacubitril‐valsartan at baseline (n = 1594). Conclusions: GALACTIC‐HF enrolled a well‐treated, high‐risk population from both inpatient and outpatient settings, which will provide a definitive evaluation of the efficacy and safety of this novel therapy, as well as informing its potential future implementation