Practising physicians individualise treatments, hoping to achieve optimal outcomes by tackling relevant patient variables. The randomised controlled trial (RCT) is universally accepted as the best means of comparison. Yet doctors sometimes wonder if particular patients might benefit more from treatments that fared worse in the RCT comparisons. Such clinicians may even feel ostracised by their peers for stepping outside treatments based on RCTs and guidelines. Are RCTs the only acceptable evaluations of how patient care can be assessed and delivered? In this controversy we explore the interpretation of RCT data for practising clinicians facing individualised patient choices. First, critical care anaesthetists John Boylan and Brian Kavanagh emphasise the dangers of bias and show how Bayesian approaches utilise prior probabilities to improve posterior (combined) probability estimates. Secondly, Jane Armitage, of the Clinical Trial Service Unit in Oxford, argues why RCTs remain essential and explores how the quality of randomisation can be improved through systematic reviews and by avoiding selective reporting.
There is debate whether the foundations of consonance and dissonance are rooted in culture or in psychoacoustics. In order to disentangle the contribution of culture and psychoacoustics, we considered automatic responses to the perfect fifth and the major second (flattened by 25 cents) intervals alongside conscious evaluations of the same intervals across two cultures and two levels of musical expertise. Four groups of participants completed the tasks: expert performers of Lithuanian Sutartines, English speaking musicians in Western diatonic genres, Lithuanian non-musicians and English-speaking non-musicians. Sutartines singers were chosen as this style of singing is an example of 'beat diaphony' where intervals of parts form predominantly rough sonorities and audible beats. There was no difference in automatic responses to intervals, suggesting that an aversion to acoustically rough intervals is not governed by cultural familiarity but may have a physical basis in how the human auditory system works. However, conscious evaluations resulted in group differences with Sutartines singers rating both the flattened major as more positive than did other groups. The results are discussed in the context of recent developments in consonance and dissonance research.
The aim of the present study is to determine which acoustic components of harmonic consonance and dissonance influence automatic responses in a simple cognitive task. In a series of experiments, ten musical interval pairs were used to measure the influence of acoustic roughness and harmonicity on response times in an affective priming task conducted online. There was a significant correlation between the difference of roughness for each pair of intervals and a response time index. Harmonicity did not influence response times on the cognitive task. More detailed analysis suggests that the presence of priming in intervals is binary: in the negative primes that create congruency effects the intervals’ fundamentals and overtones coincide within the same equivalent rectangular bandwidth (i.e. the minor and major seconds). Intervals that fall outside this equivalent rectangular bandwidth do not elicit priming effects, regardless of their dissonance or cultural conventions of negative affect. The results are discussed in the context of recent developments in consonance/dissonance research and vocal similarity.
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