The role of local meaning in infants' fixations of natural scenes.

As infants view visual scenes every day, they must shift their eye gaze and visual attention from location to location, sampling information to process and learn. Like adults, infants' gaze when viewing natural scenes (i.e., photographs of everyday scenes) is influenced by the physical features of the scene image and a general bias to look more centrally in a scene. However, it is unknown how infants' gaze while viewing such scenes is influenced by the semantic content of the scenes. Here, we tested the relative influence of local meaning, controlling for physical salience and center bias, on the eye gaze of 4- to 12-month-old infants (N = 92) as they viewed natural scenes. Overall, infants were more likely to fixate scene regions rated as higher in meaning, indicating that, like adults, the semantic content, or local meaning, of scenes influences where they look. More importantly, the effect of meaning on infant attention increased with age, providing the first evidence for an age-related increase in the impact of local meaning on infants' eye movements while viewing natural scenes.

Development and testing of patient-centered education about hormone replacement therapy for women at high genetic risk of breast and ovarian cancer.

OBJECTIVE: In this study, we aimed to develop education to assist BRCA mutation carriers in making informed decisions about HRT in the context of risk-reducing surgery, while simultaneously clarifying their treatment-specific values and reducing decisional conflict. METHODS: We enrolled premenopausal BRCA mutation carriers ages 19-49 without prior cancer or risk-reducing salpingo-oophorectomy to structured interviews in which they reviewed education about the risks and benefits of HRT. Materials included literature-derived data demonstrating associations between HRT and commonly considered health outcomes (breast cancer, vasomotor symptoms, sexual functioning, cardiovascular disease, osteoporosis, and blood clots). Participants completed the 16-item Decisional Conflict Scale (DCS) before and after education, communicated their preferences by rating and ranking the six outcomes, and provided feedback to inform iterative revisions of the educational content. RESULTS: 25 participants completed interviews. DCS scores decreased significantly from 54.6 to 22.8 following education (p < 0.001); sub-scores for uncertainty (71.7 to 37.3), informed (71.7 to 15.3), values clarity (53.7 to 17.0), effective decision (44.2 to 25.5), and support (35.0 to 17.7) also decreased significantly. Participants ranked cardiovascular disease as the most important outcome to consider, followed by breast cancer, osteoporosis, blood clots, decline in sexual function, and hot flashes. Participants with prior mastectomy (N = 10) ranked breast cancer as the most important outcome 25% of the time, compared to 80% in participants without mastectomy (N = 15). CONCLUSION: Following education, BRCA mutation carriers had significantly less decisional conflict regarding the choice to use HRT. This pilot study was successful in generating a prototype educational aid for further testing.

Cryocompression to Reduce Peripheral Neuropathy in Gynecologic Cancer: A Randomized Controlled Trial.

OBJECTIVE: To investigate the efficacy of cryocompression therapy to prevent chemotherapy-induced peripheral neuropathy. METHODS: This single-institution, randomized, self-controlled trial of cryocompression enrolled gynecologic cancer patients planned for five to six cycles neurotoxic chemotherapy. Exclusion criteria were prior neurotoxic chemotherapy or baseline peripheral neuropathy. Participants were randomized to cryocompression on dominant versus non-dominant hand and foot (treatment), with no intervention on the opposite side (control). Compression socks and gloves and ice bags were applied 15 minutes before, during, and 15 minutes after infusion. Primary outcome measures included the PNQ (Patient Neurotoxicity Questionnaire) and the Semmes-Weinstein monofilament test; secondary outcomes included the FACT/GOG-NTX (Functional Assessment of Cancer Therapy/Gynecologic Oncology Group - Neurotoxicity) and patient acceptability and tolerability. Sixty patients completing the study were necessary to detect a 70% reduction in the odds of PNQ grade C or higher peripheral sensory neuropathy with 80% power. RESULTS: Ninety-one patients were enrolled from January 2021 to October 2022; 69 were eligible for final analysis. Of the 91 patients, 64.8% were White, 30.8% were Black, and 1.1% were Hispanic or Latina. With successive cycles, more patients had sensory PNQ grade C or higher neuropathy on the control side compared with the cryocompression side. Cryocompression decreased the odds of sensory neuropathy (PNQ grade C or higher) by 46% at final visit (odds ratio 0.54, 95% CI 0.31-0.94; P =.03). There was no difference in tactile sensitivity based on the monofilament test between sides at the final visit. At the final visit, average FACT/GOG-NTX-11 (Functional Assessment of Cancer Therapy/Gynecologic Oncology Group - Neurotoxicity 11 Item Version) scores were significantly lower on the cryocompression than the control side (estimate -0.97, 95% CI -1.89 to -0.06; P =.04), as were FACT/GOG-NTX-4 (Functional Assessment of Cancer Therapy/Gynecologic Oncology Group - Neurotoxicity 4 Item Version) scores (estimate -0.35, 95% CI -0.64 to -0.05; P =.02). More than 85% of patients assessed the intervention as acceptable and tolerable. CONCLUSIONS: Cryocompression therapy reduces subjective chemotherapy-induced peripheral sensory neuropathy in patients who are receiving paclitaxel or cisplatin for gynecologic cancer. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov , NCT04563130.

Transformers bridge vision and language to estimate and understand scene meaning.

Humans rapidly process and understand real-world scenes with ease. Our stored semantic knowledge gained from experience is thought to be central to this ability by organizing perceptual information into meaningful units to efficiently guide our attention in scenes. However, the role stored semantic representations play in scene guidance remains difficult to study and poorly understood. Here, we apply a state-of-the-art multimodal transformer trained on billions of image-text pairs to help advance our understanding of the role semantic representations play in scene understanding. We demonstrate across multiple studies that this transformer-based approach can be used to automatically estimate local scene meaning in indoor and outdoor scenes, predict where people look in these scenes, detect changes in local semantic content, and provide a human-interpretable account of why one scene region is more meaningful than another. Taken together, these findings highlight how multimodal transformers can advance our understanding of the role scene semantics play in scene understanding by serving as a representational framework that bridges vision and language.

A Horse of a Different Color: A Case Report of Streptococcus Equi Meningitis in a Kidney Transplant Recipient.

Streptococcus equi is an opportunistic pathogen in horses that has rarely been transmitted to humans. Here we present a zoonotic S. equi meningitis case in a kidney transplant recipient with exposure to infected horses. We discuss the patient's risk factors, clinical presentation, and management in the context of the limited literature on S. equi meningitis.

A Pilot Study of a Screening Program for Human Papillomavirus-Related Squamous Intraepithelial Lesion and Malignancy in Gynecologic Oncology Patients.

OBJECTIVE: Human papillomavirus (HPV)-related squamous intraepithelial lesion (SIL) or malignancy is associated with a significantly increased risk of second-site SIL or malignancy. The primary objective of this study was to determine the feasibility and acceptability of concurrent anal, cervical, and vulvovaginal screening in patients with a history of HPV-related gynecologic high-grade SIL or malignancy. The secondary objective was to assess subjects' knowledge regarding HPV screening and risks. METHODS: Women with high-grade cervical, vulvar, or vaginal SIL or malignancy were enrolled during a 1-year pilot period. Subjects with cervical SIL or malignancy underwent vulvar examination and anoscopy. Subjects with vulvovaginal SIL or malignancy underwent Pap test if indicated and anoscopy. Appropriate referrals were made for abnormal findings. Feasibility was assessed by compliance using study acceptance rate, screening procedure adherence, and referral adherence. Acceptability was assessed using a Likert-scaled question after completion of screening procedures. RESULTS: One hundred three women with a diagnosis of high-grade vulvovaginal or cervical SIL or carcinoma were approached regarding study enrollment; of these, 74 (71.8%) enrolled. The median score on the HPV knowledge assessment was 8.1 ± 1.6 (max score 10). Seventy-three (98.6%) of 74 patients rated the screening procedures as acceptable (score of 5/5). On examination, 14 (18.9%) subjects had abnormalities noted; 7 (9.5%) were referred for colorectal surgical evaluation, and 6/7 (85.7%) were compliant with their referral appointments. CONCLUSIONS: Screening examinations for other HPV-related SILs and malignancies, including Pap tests, vulvovaginal inspection, and anoscopy, are acceptable to patients, with abnormal findings in almost 1 in 5 women.

Searching for meaning: Local scene semantics guide attention during natural visual search in scenes.

Models of visual search in scenes include image salience as a source of attentional guidance. However, because scene meaning is correlated with image salience, it could be that the salience predictor in these models is driven by meaning. To test this proposal, we generated meaning maps that represented the spatial distribution of semantic informativeness in scenes, and salience maps which represented the spatial distribution of conspicuous image features and tested their influence on fixation densities from two object search tasks in real-world scenes. The results showed that meaning accounted for significantly greater variance in fixation densities than image salience, both overall and in early attention across both studies. Here, meaning explained 58% and 63% of the theoretical ceiling of variance in attention across both studies, respectively. Furthermore, both studies demonstrated that fast initial saccades were not more likely to be directed to higher salience regions than slower initial saccades, and initial saccades of all latencies were directed to regions containing higher meaning than salience. Together, these results demonstrated that even though meaning was task-neutral, the visual system still selected meaningful over salient scene regions for attention during search.

Visual attention during seeing for speaking in healthy aging.

As we age, we accumulate a wealth of information about the surrounding world. Evidence from visual search suggests that older adults retain intact knowledge for where objects tend to occur in everyday environments (semantic information) that allows them to successfully locate objects in scenes, but may overrely on semantic guidance. We investigated age differences in the allocation of attention to semantically informative and visually salient information in a task in which the eye movements of younger (N = 30, aged 18-24) and older (N = 30, aged 66-82) adults were tracked as they described real-world scenes. We measured the semantic information in scenes based on "meaning map" ratings from a norming sample of young and older adults, and image salience as graph-based visual saliency. Logistic mixed-effects modeling was used to determine whether, controlling for center bias, fixated scene locations differed in semantic informativeness and visual salience from locations that were not fixated, and whether these effects differed for young and older adults. Semantic informativeness predicted fixated locations well overall, as did image salience, although unique variance in the model was better explained by semantic informativeness than image salience. Older adults were less likely to fixate informative locations in scenes than young adults were, though the locations older adults' fixated were independently predicted well by informativeness. These results suggest young and older adults both use semantic information to guide attention in scenes and that older adults do not overrely on semantic information across the board. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Telemedicine and gynecologic oncology: caring for patients remotely during a global pandemic.

BACKGROUND: Telemedicine uses technology to deliver medical care remotely and has been shown to provide similar patient satisfaction and care outcomes compared with in-person visits. OBJECTIVE: This study aimed to assess the gynecologic oncology patient telehealth experience. STUDY DESIGN: All patients receiving telehealth care between March 23, 2020, to May 14, 2020, from a single institution's gynecologic oncology division were offered postvisit surveys to assess satisfaction. Basic demographic and clinical data were collected and analyzed with descriptive statistics. Patient zip code data were correlated with Community Need Index scores and visualized using heat maps. RESULTS: Of 286 telehealth visits, 112 postvisit surveys (39.2%) were collected. Survey responses demonstrated high patient satisfaction with responders agreeing that privacy was respected (97.3%), diagnosis and treatment options were adequately explained (92%), they could easily ask questions (97.3%), and they established a good rapport with their provider (96.4%). Additional benefits included reduced travel (92.9%), time (83.0%), cost (67.9%), and family interruption (57.1%). Among 11 patients receiving treatment on a clinical trial, 10 (90.9%) were able to continue on trial without disruption. Most responders (87.5%) preferred future visits to occur via telehealth or a mixture of telehealth and in-person visits. No difference in satisfaction was found among patients residing in zip codes associated with higher Community Need Index scores or increased distance from the institution. CONCLUSION: The use of telemedicine in providing gynecologic oncology care was associated with high patient satisfaction and had the benefits of reduced time, cost, travel, and interruption to family time.

Scene inversion reveals distinct patterns of attention to semantically interpreted and uninterpreted features.

Semantic guidance theories propose that attention in real-world scenes is strongly associated with semantically informative scene regions. That is, we look where there are recognizable and informative objects that help us make sense of our visual environment. In contrast, image guidance theories propose that local differences in semantically uninterpreted image features such as luminance, color, and edge orientation primarily determine where we look in scenes. While it is clear that both semantic guidance and image guidance play a role in where we look in scenes, the degree of their relative contributions and how they interact with each other remains poorly understood. In the current study, we presented real-world scenes in upright and inverted orientations and used general linear mixed effects models to understand how semantic guidance, image guidance, and observer center bias were associated with fixation location and fixation duration. We observed distinct patterns of change under inversion. Semantic guidance was severely disrupted by scene inversion, while image guidance was mildly impaired and observer center bias was enhanced. In addition, we found that fixation durations for semantically rich regions decreased when viewing inverted scenes relative to upright scene viewing, while fixation durations for image salience and center bias were unaffected by inversion. Together these results provide important new constraints on theories and computational models of attention in real-world scenes.

Look at what I can do: Object affordances guide visual attention while speakers describe potential actions.

As we act on the world around us, our eyes seek out objects we plan to interact with. A growing body of evidence suggests that overt visual attention selects objects in the environment that could be interacted with, even when the task precludes physical interaction. In previous work, objects that afford grasping interactions influenced attention when static scenes depicted reachable spaces, and attention was otherwise better explained by general informativeness. Because grasping is but one of many object interactions, previous work may have downplayed the influence of object affordances on attention. The current study investigated the relationship between overt visual attention and object affordances versus broadly construed semantic information in scenes as speakers describe or memorize scenes. In addition to meaning and grasp maps-which capture informativeness and grasping object affordances in scenes, respectively-we introduce interact maps, which capture affordances more broadly. In a mixed-effects analysis of 5 eyetracking experiments, we found that meaning predicted fixated locations in a general description task and during scene memorization. Grasp maps marginally predicted fixated locations during action description for scenes that depicted reachable spaces only. Interact maps predicted fixated regions in description experiments alone. Our findings suggest observers allocate attention to scene regions that could be readily interacted with when talking about the scene, while general informativeness preferentially guides attention when the task does not encourage careful consideration of objects in the scene. The current study suggests that the influence of object affordances on visual attention in scenes is mediated by task demands.

Investigating factors that influence genetic counselors' decisions to refer patients to mental health providers.

Genetic counselors (GC) serve patients who are often in distress at the time of their consultation. GC competency includes providing short-term, client-centered counseling, while using community resources, such as mental health providers (MHPs), for psychosocial support. The purpose of this study was to assess the mental health referral practices of GCs; specifically, the rate of referrals, factors influencing a GC's decision to refer, and barriers to referrals. GCs working in direct patient care for at least one year were recruited to take a novel 27 question survey created based on the results of a previous qualitative study. A link to the web-based survey was distributed through the National Society of Genetic Counselors Student Research Program and American Board of Genetic Counselors by email. A total of 144 individuals opened the survey for an estimated response rate of 3%. A majority of respondents (54.3%) reported they assess a patient's need for a mental health referral at least half of the time. The mean number of referrals made in the past 12 months was 5.13. After post-hoc analyses, there were no differences in referral rates between specialties. Common referral indications included patient history of mental illness, distress about having a genetic condition, and limited social support. Common barriers to referral were financial or insurance related, patient receptiveness, and the patient not perceiving a benefit. GCs felt that providing psychosocial support is within their scope of practice, but that MHPs are better equipped to manage long-term needs and those related to a mental health condition. This study provides insight into how GCs decide when they can manage patient distress, circumstances that prompt a referral to MHPs, and barriers. Recognizing common referral indications and barriers may lead to better strategies for connecting patients with such services.

Meaning maps detect the removal of local semantic scene content but deep saliency models do not.

Meaning mapping uses human raters to estimate different semantic features in scenes, and has been a useful tool in demonstrating the important role semantics play in guiding attention. However, recent work has argued that meaning maps do not capture semantic content, but like deep learning models of scene attention, represent only semantically-neutral image features. In the present study, we directly tested this hypothesis using a diffeomorphic image transformation that is designed to remove the meaning of an image region while preserving its image features. Specifically, we tested whether meaning maps and three state-of-the-art deep learning models were sensitive to the loss of semantic content in this critical diffeomorphed scene region. The results were clear: meaning maps generated by human raters showed a large decrease in the diffeomorphed scene regions, while all three deep saliency models showed a moderate increase in the diffeomorphed scene regions. These results demonstrate that meaning maps reflect local semantic content in scenes while deep saliency models do something else. We conclude the meaning mapping approach is an effective tool for estimating semantic content in scenes.

Linking patterns of infant eye movements to a neural network model of the ventral stream using representational similarity analysis.

Little is known about the development of higher-level areas of visual cortex during infancy, and even less is known about how the development of visually guided behavior is related to the different levels of the cortical processing hierarchy. As a first step toward filling these gaps, we used representational similarity analysis (RSA) to assess links between gaze patterns and a neural network model that captures key properties of the ventral visual processing stream. We recorded the eye movements of 4- to 12-month-old infants (N = 54) as they viewed photographs of scenes. For each infant, we calculated the similarity of the gaze patterns for each pair of photographs. We also analyzed the images using a convolutional neural network model in which the successive layers correspond approximately to the sequence of areas along the ventral stream. For each layer of the network, we calculated the similarity of the activation patterns for each pair of photographs, which was then compared with the infant gaze data. We found that the network layers corresponding to lower-level areas of visual cortex accounted for gaze patterns better in younger infants than in older infants, whereas the network layers corresponding to higher-level areas of visual cortex accounted for gaze patterns better in older infants than in younger infants. Thus, between 4 and 12 months, gaze becomes increasingly controlled by more abstract, higher-level representations. These results also demonstrate the feasibility of using RSA to link infant gaze behavior to neural network models. A video abstract of this article can be viewed at https://youtu.be/K5mF2Rw98Is.

Rapid Extraction of the Spatial Distribution of Physical Saliency and Semantic Informativeness from Natural Scenes in the Human Brain.

Physically salient objects are thought to attract attention in natural scenes. However, research has shown that meaning maps, which capture the spatial distribution of semantically informative scene features, trump physical saliency in predicting the pattern of eye moments in natural scene viewing. Meaning maps even predict the fastest eye movements, suggesting that the brain extracts the spatial distribution of potentially meaningful scene regions very rapidly. To test this hypothesis, we applied representational similarity analysis to ERP data. The ERPs were obtained from human participants (N = 32, male and female) who viewed a series of 50 different natural scenes while performing a modified 1-back task. For each scene, we obtained a physical saliency map from a computational model and a meaning map from crowd-sourced ratings. We then used representational similarity analysis to assess the extent to which the representational geometry of physical saliency maps and meaning maps can predict the representational geometry of the neural response (the ERP scalp distribution) at each moment in time following scene onset. We found that a link between physical saliency and the ERPs emerged first (∼78 ms after stimulus onset), with a link to semantic informativeness emerging soon afterward (∼87 ms after stimulus onset). These findings are in line with previous evidence indicating that saliency is computed rapidly, while also indicating that information related to the spatial distribution of semantically informative scene elements is computed shortly thereafter, early enough to potentially exert an influence on eye movements.SIGNIFICANCE STATEMENT Attention may be attracted by physically salient objects, such as flashing lights, but humans must also be able to direct their attention to meaningful parts of scenes. Understanding how we direct attention to meaningful scene regions will be important for developing treatments for disorders of attention and for designing roadways, cockpits, and computer user interfaces. Information about saliency appears to be extracted rapidly by the brain, but little is known about the mechanisms that determine the locations of meaningful information. To address this gap, we showed people photographs of real-world scenes and measured brain activity. We found that information related to the locations of meaningful scene elements was extracted rapidly, shortly after the emergence of saliency-related information.

Meaning and expected surfaces combine to guide attention during visual search in scenes.

How do spatial constraints and meaningful scene regions interact to control overt attention during visual search for objects in real-world scenes? To answer this question, we combined novel surface maps of the likely locations of target objects with maps of the spatial distribution of scene semantic content. The surface maps captured likely target surfaces as continuous probabilities. Meaning was represented by meaning maps highlighting the distribution of semantic content in local scene regions. Attention was indexed by eye movements during the search for target objects that varied in the likelihood they would appear on specific surfaces. The interaction between surface maps and meaning maps was analyzed to test whether fixations were directed to meaningful scene regions on target-related surfaces. Overall, meaningful scene regions were more likely to be fixated if they appeared on target-related surfaces than if they appeared on target-unrelated surfaces. These findings suggest that the visual system prioritizes meaningful scene regions on target-related surfaces during visual search in scenes.

Deep saliency models learn low-, mid-, and high-level features to predict scene attention.

Deep saliency models represent the current state-of-the-art for predicting where humans look in real-world scenes. However, for deep saliency models to inform cognitive theories of attention, we need to know how deep saliency models prioritize different scene features to predict where people look. Here we open the black box of three prominent deep saliency models (MSI-Net, DeepGaze II, and SAM-ResNet) using an approach that models the association between attention, deep saliency model output, and low-, mid-, and high-level scene features. Specifically, we measured the association between each deep saliency model and low-level image saliency, mid-level contour symmetry and junctions, and high-level meaning by applying a mixed effects modeling approach to a large eye movement dataset. We found that all three deep saliency models were most strongly associated with high-level and low-level features, but exhibited qualitatively different feature weightings and interaction patterns. These findings suggest that prominent deep saliency models are primarily learning image features associated with high-level scene meaning and low-level image saliency and highlight the importance of moving beyond simply benchmarking performance.

Developmental changes in natural scene viewing in infancy.

We extend decades of research on infants' visual processing by examining their eye gaze during viewing of natural scenes. We examined the eye movements of a racially diverse group of 4- to 12-month-old infants (N = 54; 27 boys; 24 infants were White and not Hispanic, 30 infants were African American, Asian American, mixed race and/or Hispanic) as they viewed images selected from the MIT Saliency Benchmark Project. In general, across this age range infants' fixation distributions became more consistent and more adult-like, suggesting that infants' fixations in natural scenes become increasingly more systematic. Evaluation of infants' fixation patterns with saliency maps generated by different models of physical salience revealed that although over this age range there was an increase in the correlations between infants' fixations and saliency, the amount of variance accounted for by salience actually decreased. At the youngest age, the amount of variance accounted for by salience was very similar to the consistency between infants' fixations, suggesting that the systematicity in these youngest infants' fixations was explained by their attention to physically salient regions. By 12 months, in contrast, the consistency between infants was greater than the variance accounted for by salience, suggesting that the systematicity in older infants' fixations reflected more than their attention to physically salient regions. Together these results show that infants' fixations when viewing natural scenes becomes more systematic and predictable, and that predictability is due to their attention to features other than physical salience. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Looking for Semantic Similarity: What a Vector-Space Model of Semantics Can Tell Us About Attention in Real-World Scenes.

The visual world contains more information than we can perceive and understand in any given moment. Therefore, we must prioritize important scene regions for detailed analysis. Semantic knowledge gained through experience is theorized to play a central role in determining attentional priority in real-world scenes but is poorly understood. Here, we examined the relationship between object semantics and attention by combining a vector-space model of semantics with eye movements in scenes. In this approach, the vector-space semantic model served as the basis for a concept map, an index of the spatial distribution of the semantic similarity of objects across a given scene. The results showed a strong positive relationship between the semantic similarity of a scene region and viewers' focus of attention; specifically, greater attention was given to more semantically related scene regions. We conclude that object semantics play a critical role in guiding attention through real-world scenes.

Meaning maps capture the density of local semantic features in scenes: A reply to Pedziwiatr, Kümmerer, Wallis, Bethge & Teufel (2021).

Pedziwiatr, Kümmerer, Wallis, Bethge, & Teufel (2021) contend that Meaning Maps do not represent the spatial distribution of semantic features in scenes. We argue that Pesziwiatr et al. provide neither logical nor empirical support for that claim, and we conclude that Meaning Maps do what they were designed to do: represent the spatial distribution of meaning in scenes.