Identifying strategies to maximise recruitment and retention of practices and patients in a multicentre randomised controlled trial of an intervention to optimise secondary prevention for coronary heart disease in primary care.

Background Recruitment and retention of patients and healthcare providers in randomised controlled trials (RCTs) is important in order to determine the effectiveness of interventions. However, failure to achieve recruitment targets is common and reasons why a particular recruitment strategy works for one study and not another remain unclear. We sought to describe a strategy used in a multicentre RCT in primary care, to report researchers’ and participants’ experiences of its implementation and to inform future strategies to maximise recruitment and retention. Methods In total 48 general practices and 903 patients were recruited from three different areas of Ireland to a RCT of an intervention designed to optimise secondary prevention of coronary heart disease. The recruitment process involved telephoning practices, posting information, visiting practices, identifying potential participants, posting invitations and obtaining consent. Retention involved patients attending reviews and responding to questionnaires and practices facilitating data collection. Results We achieved high retention rates for practices (100%) and for patients (85%) over an 18-month intervention period. Pilot work, knowledge of the setting, awareness of change in staff and organisation amongst participant sites, rapid responses to queries and acknowledgement of practitioners’ contributions were identified as being important. Minor variations in protocol and research support helped to meet varied, complex and changing individual needs of practitioners and patients and encouraged retention in the trial. A collaborative relationship between researcher and practice staff which required time to develop was perceived as vital for both recruitment and retention. Conclusions Recruiting and retaining the numbers of practices and patients estimated as required to provide findings with adequate power contributes to increased confidence in the validity and generalisability of RCT results. A continuous dynamic process of monitoring progress within trials and tailoring strategies to particular circumstances, whilst not compromising trial protocols, should allow maximal recruitment and retention.

Spatial Perception and Cognition in Multichannel Audio for Electroacoustic Music

Listeners experience electroacoustic music as full of significance and meaning, and they experience spatiality as one of the factors contributing to its meaningfulness. If we want to understand spatiality in electroacoustic music, we must understand how the listener’s mental processes give rise to the experience of meaning. In electroacoustic music as in everyday life, these mental processes unite the peripheral auditory system with human spatial cognition. In the discussion that follows we consider a range of the listener’s mental processes relating space and meaning from the perceptual attributes of spatial imagery to the spatial reference frames for places and navigation. When considering multichannel loudspeaker systems in particular, an important part of the discussion is focused on the distinctive and idiomatic ways in which this particular mode of sound production contributes to and situates meaning. These idiosyncrasies include the phenomenon of image dispersion, the important consequences of the precedence effect and the influence of source characteristics on spatial imagery. These are discussed in close relation to the practicalities of artistic practice and to the potential for artistic meaning experienced by the listener.

Impure Thinking Practices and Clinical Acts: The Sonorous Becomings of Heidi Fast

This article introduces the recent sound works of Heidi Fast, a Finnish voice and performance artist. Fast’s creative practice operates between art and philosophy, and articulates several ‘zones of becoming’: what Fast designates as ‘the clinical’, ‘the virtual’ and ‘vocal thought-material’. Using a methodology of routing, the article shows how these zones emerge as aesthetic, ethical and political concerns within Fast’s work. Since 2005, Fast’s sound works have variously taken shape as miniature concerts, social sculptures, imaginary soundscapes and environmental music performances. Drawing upon the writings of theorists who have helped shape her practice, this article argues that Fast uses sound and voice to propose an ‘actualising philosophy’. This philosophy actualises virtualities (unrealised potentials), affecting transformative shifts through tiny mutations in perceptions and behaviours.