Speech Sound Categories Affect Lexical Competition: Implications for Analytic Auditory Training.

OBJECTIVES: We provide a novel application of psycholinguistic theories and methods to the field of auditory training to provide preliminary data regarding which minimal pair contrasts are more difficult for listeners with typical hearing to distinguish in real-time. DESIGN: Using eye-tracking, participants heard a word and selected the corresponding image from a display of four: the target word, two unrelated words, and a word from one of four contrast categories (i.e., voiced-initial [e.g., peach-beach], voiced-final [e.g., back-bag], manner-initial [e.g., talk-sock], and manner-final [e.g., bat-bass]). RESULTS: Fixations were monitored to measure how strongly words compete for recognition depending on the contrast type (voicing, manner) and location (word-initial or final). Manner contrasts competed more for recognition than did voicing contrasts, and contrasts that occurred in word-final position were harder to distinguish than word-initial position. CONCLUSION: These results are an important initial step toward creating an evidence-based hierarchy for auditory training for individuals who use cochlear implants.

Inhibition of lexical representations after violated semantic predictions.

There is a consensus that humans predict upcoming words during sentence processing. Prediction makes language comprehension fast and efficient if this anticipatory processing is accurate. However, often times, predictions are not correct. There is a lack of research investigating the cognitive operations at play when predictions are violated. According to several proposals, such violations lead to an inhibition of the predicted word to facilitate the integration of the unexpected word. Across four experiments, we have tested whether predicted words are indeed inhibited when listeners encounter unexpected stimuli, and whether the linguistic status (word or sound) and semantic congruency of a word (plausible or implausible) influences this purported inhibitory process. Using a Cross-Modal Lexical Priming paradigm, we showed that when predictions are violated, the activation of the predicted word is inhibited, resulting in increased reaction times. These inhibitory effects appear to be language specific, in that they are only observed after unexpected words, as opposed to non-linguistic sounds (tones). However, contrary to a long-held assumption in the field of sentence processing, inhibitory effects are not modulated by the semantic congruency of the unexpected word (i.e., whether the unexpected word is plausible within the sentence context). Indeed, in the current study, any linguistic information that violated listeners' semantic prediction resulted in the inhibition of the predicted word. Thus, the current findings are more compatible with a view in which unexpected linguistic events that are meaningful engage inhibitory processes with the specific purpose of inhibiting the predicted, though out-of-date, word.

Virtual interviewing in the MedPhys match: Experiences of applicants and programs.

PURPOSE: The purpose of this survey study is to compare the experiences of programs and applicants in the MedPhys Match (MPM) in the 2020-21 match cycle with experiences reported from previous match cycles. The 2020-21 match cycle was unique in that recruitment and interviewing were almost exclusively virtual during the COVID-19 pandemic. METHODS: A survey was sent to all applicants and programs registered for the 2020-21 MPM. Survey questions asked about the pre-interview screening, interview, ranking, and post-match stages of the residency match process. Survey data were analyzed using graphical methods and spreadsheet tools. RESULTS: Advantages and disadvantages to the virtual interviewing experience were reported by applicants and program directors (PDs). The advantages included reduced cost and greater scheduling flexibility with fewer scheduling conflicts, allowing applicants to consider more programs. These advantages greatly outweighed the disadvantages such as the inability to meet faculty/staff and current residents in person and gauge the feel of the program. PDs recognized the advantages of minimal costs and time savings for applicants. Programs reported it was difficult to convey workplace culture and the physical environment and to gauge personality and interpersonal skills of the applicants. CONCLUSION: The virtual interviewing environment for residency recruitment in medical physics is strongly preferred by applicants over required in-person interviews. The advantages identified by applicants outweigh the disadvantages, allowing applicants to feel confident in their ranking decisions and overall satisfied with their match results. PDs acknowledge the greater equity of access to interviews for applicants in the virtual environment, however, they are overall less satisfied with their ability to showcase their program's strengths and to assess the personality of applicants. Caution is urged when considering a hybrid interview model to ensure fair assessments that do not depend on whether an applicant chooses to accept an optional in-person interview or site visit.

A First Look at Equity, Diversity, and Inclusion of Canadian Medical Physicists: Results From the 2021 COMP EDI Climate Survey.

PURPOSE: In 2021, the Canadian Organization of Medical Physicists (COMP) conducted its first equity, diversity, and inclusion Climate Survey. The membership's experiences of inclusion, belonging, professional opportunities, discrimination, microaggressions, racism, and harassment in their professional lives are presented. METHODS AND MATERIALS: The ethics-reviewed survey was distributed in English and French to full members of COMP. Participants responded to questions covering demographics and professional climate. Simple descriptive statistics were used to measure frequency of responses. Data pertaining to impressions on the climate within the profession were compared using nonparametric statistical tests. RESULTS: The survey was distributed to 649 eligible members; 243 (37%) responded, and 214 (33%) provided full response sets. From the full response sets, findings showed that in general, age, highest academic degree, and racial and ethnic distribution trends of medical physicists were comparable with previously collected data and/or the Canadian population. The experiences of respondents relating to harassment in the workplace and perception of climate are reported and provide a useful benchmark for future assessments of interventions or training programs. In the workplace, fewer women (58%) reported having professional opportunities compared with men (70%). The survey also found that 17% of respondents (most of whom were women) directly or indirectly experienced sexual harassment in the workplace within the past 5 years. Finding that 23% of survey respondents identified as having a disability is a valuable reminder that accommodations in the workplace are necessary for more than 1 in every 5 medical physicists working in clinics. CONCLUSIONS: This study provided insight into the diversity and experiences of medical physicists in Canada. The majority of respondents had positive perceptions about their professional environment. However, equity-lacking groups were identified, such as women, underrepresented minorities, Indigenous peoples, and people with visible and invisible disabilities.

2021 AAPM Equity, Diversity, and Inclusion Climate Survey Executive Summary.

PURPOSE: The American Association of Physicists in Medicine (AAPM) shares the results, conclusions, and recommendations from the initial Equity, Diversity, and Inclusion Climate Survey conducted in 2021. METHODS AND MATERIALS: The climate survey targeted medical physicists who are full members of the AAPM and included demographic inquiries and questions intended to assess the working environmental climate in terms of a sense of belonging and inclusion, experiences of discrimination and harassment, and obstacles to participation within the AAPM. The survey invitation was sent to 5,500 members. Responses were collected from 1385 members (response rate of 25%) between January and February 2021. RESULTS: Overall, the medical physics workplace climate was positive. However, some demographic and professional subgroups reported lower levels of agreement with positive characteristics of their workplace climates. Compared with men, women ranked lower 7 of 8 categories that characterized the workplace climate. Other subgroups that also ranked the workplace climate descriptors lower included individuals not originally from the United States and Canada (3/8). Most respondents strongly agreed/agreed that the climate within the AAPM was welcoming. However, 17% of respondents reported personally experiencing or witnessing microaggressions within the AAPM. Overall, medical physicists reported low levels of agreement that opportunities within the AAPM were available to them, from 34% to 60% among 8 categories, including opportunities to volunteer, join committees, and compete for leadership positions within the AAPM. Several subgroups reported even lower levels of agreement that these opportunities are available. Asian and Asian American respondents (3/8) and physicists with origins in countries outside the United States and Canada (7/8) reported fewer opportunities to participate in the AAPM. Medical physicists reported their experiences of discrimination and sexual harassment in their workplaces and within the AAPM. For those who reported personal experiences of sexual harassment, only 24% (15/63) felt comfortable reporting when it occurred within their workplaces, and 35% (9/26) felt comfortable reporting when it occurred within the AAPM. CONCLUSIONS: The report concludes with several recommendations for action.

Barriers to Equity in Pediatric Hearing Health Care: A Review of the Evidence.

Purpose: We review the evidence regarding barriers to hearing health care for children who are deaf or hard of hearing. Background: There are considerable data to suggest that hearing health care disparities constitute a major factor in loss to follow-up or documentation for children going through the Early Hearing Detection and Intervention process. Families are affected by a combination of factors underlying these disparities, resulting in delayed care and suboptimal developmental outcomes for children who are deaf or hard of hearing. Conclusions: To address the socioeconomic, cultural, and linguistic inequities seen in the diagnosis and management of childhood hearing loss, pediatric audiologists and speech-language pathologists have a responsibility to provide culturally responsive practice to their individual clients and their families, as well as advocate for substantive changes at the policy level that impact their clients' daily lives.

The Role of Orthography and Phonology in Written Word Recognition: Evidence From Eye-Tracking in the Visual World Paradigm.

PURPOSE: There is a long-standing debate about how written words are recognized. Central to this debate is the role of phonology. The objective of this study is to contribute to our collective understanding regarding the role of phonology in written word recognition. METHOD: A total of 30 monolingual adults were tested using a novel written word version of the visual world paradigm (VWP). We compared activation of phonological anadromes (words that are matched for sounds but not letters, e.g., JAB-BADGE) and orthographic anadromes (words that are matched for letters but not sounds, e.g., LEG-GEL) to determine the relative role of phonology and orthography in familiar single-word reading. RESULTS: We found that activation for phonological anadromes is earlier, more robust, and sustained longer than orthographic anadromes. CONCLUSIONS: These results are most consistent with strong phonological theories of single-word reading that posit an early and robust role of phonology. This study has broad implications for larger debates regarding reading instruction.

Automated planning stage tracking and analysis through an integrated whiteboard system.

PURPOSE: One of the common challenges in delivering complex healthcare procedures such as radiation oncology is the organization and sharing of information in ways that facilitate workflow and prevent treatment delays. Within the major vendors of Oncology Information Systems (OIS) is a lack of tools and displays to assist in task timing and workflow processes. To address this issue, we developed an electronic whiteboard integrated with a local OIS to track, record, and evaluate time frames associated with clinical radiation oncology treatment planning processes. METHODS: We developed software using an R environment hosted on a local web-server at Seattle Cancer Care Alliance (SCCA) in 2017. The planning process was divided into stages, and time-stamped moves between planning stages were recorded automatically via Mosaiq (Elekta, Sweden) Quality Check Lists (QCLs). Whiteboard logs were merged with Mosaiq-extracted diagnostic factors and evaluated for significance. Interventional changes to task time expectations were evaluated for 6 months in 2021 and compared with 6 month periods in 2018 and 2019. RESULTS: Whiteboard/Mosaiq data from the SCCA show that treatment intent, number of prescriptions, and nodal involvement were main factors influencing overall time to plan completion. Contouring and Planning times were improved by 2.6 days (p<10-14) and 2.5 days (p<10-11), respectively. Overall time to plan completion was reduced by 33% (5.1 days; p<10-11). CONCLUSIONS: This report establishes the utility of real-time task tracking tools in a radiotherapy planning process. The whiteboard results provide data-driven evidence to add justification for practice change implementations.

The profile of real-time competition in spoken and written word recognition: More similar than different.

Word recognition occurs across two sensory modalities: auditory (spoken words) and visual (written words). While each faces different challenges, they are often described in similar terms as a competition process by which multiple lexical candidates are activated and compete for recognition. While there is a general consensus regarding the types of words that compete during spoken word recognition, there is less consensus for written word recognition. The present study develops a novel version of the Visual World Paradigm (VWP) to examine written word recognition and uses this to assess the nature of the competitor set during word recognition in both modalities using the same experimental design. For both spoken and written words, we found evidence for activation of onset competitors (cohorts, e.g., cat, cap) and words that contain the same phonemes or letters in reverse order (anadromes, e.g., cat, tack). We found no evidence of activation for rhymes (e.g., cat, hat). The results across modalities were quite similar, with the exception that for spoken words, cohorts were more active than anadromes, whereas for written words activation was similar. These results suggest a common characterisation of lexical similarity across spoken and written words: temporal or spatial order is coarsely coded, and onsets may receive more weight in both systems. However, for spoken words, temporary ambiguity during the moment of processing gives cohorts an additional boost during real-time recognition.

The Recognition of Whispered Speech in Real-Time.

OBJECTIVES: Whispered speech offers a unique set of challenges to speech perception and word recognition. The goals of the present study were twofold: First, to determine how listeners recognize whispered speech. Second, to inform major theories of spoken word recognition by considering how recognition changes when major cues to phoneme identity are reduced or largely absent compared with normal voiced speech. DESIGN: Using eye tracking in the Visual World Paradigm, we examined how listeners recognize whispered speech. After hearing a target word (normal or whispered), participants selected the corresponding image from a display of four-a target (e.g., money), a word that shares sounds with the target at the beginning (cohort competitor, e.g., mother), a word that shares sounds with the target at the end (rhyme competitor, e.g., honey), and a phonologically unrelated word (e.g., whistle). Eye movements to each object were monitored to measure (1) how fast listeners process whispered speech, and (2) how strongly they consider lexical competitors (cohorts and rhymes) as the speech signal unfolds. RESULTS: Listeners were slower to recognize whispered words. Compared with normal speech, listeners displayed slower reaction times to click the target image, were slower to fixate the target, and fixated the target less overall. Further, we found clear evidence that the dynamics of lexical competition are altered during whispered speech recognition. Relative to normal speech, words that overlapped with the target at the beginning (cohorts) displayed slower, reduced, and delayed activation, whereas words that overlapped with the target at the end (rhymes) exhibited faster, more robust, and longer lasting activation. CONCLUSION: When listeners are confronted with whispered speech, they engage in a "wait-and-see" approach. Listeners delay lexical access, and by the time they begin to consider what word they are hearing, the beginning of the word has largely come and gone, and activation for cohorts is reduced. However, delays in lexical access actually increase consideration of rhyme competitors; the delay pushes lexical activation to a point later in processing, and the recognition system puts more weight on the word-final overlap between the target and the rhyme.

MPLA Case 3: Don't criticize me in public!

This work of fiction re-enacts a scenario in which a medical physics resident was not able to address a physics call during patient simulation and was criticized by the supervising faculty physicist in front of the team and the patient. The resident and the faculty agreed to meet afterwards to debrief the situation, in the hope of establishing a better working relationship. The intended use of this case, through group discussion, self-study, or role-play, is to encourage readers to discuss the situation at hand, inspire professionalism and leadership thinking, and allow the practice of conflict management. Facilitator's notes are available upon request to the MPLA Cases Subcommittee. This case study falls under the scope of and is supported by the Medical Physics Leadership Academy (MPLA), a committee in the American Association of Physicists in Medicine (AAPM).

AAPM medical physics practice guideline 3.b.: Levels of supervision for medical physicists in clinical training.

The American Association of Physicists in Medicine (AAPM) is a nonprofit professional society whose primary purposes are to advance the science, education and professional practice of medical physics. The AAPM has more than 8,000 members and is the principal organization of medical physicists in the United States. The AAPM will periodically define new practice guidelines for medical physics practice to help advance the science of medical physics and to improve the quality of service to patients throughout the United States. Existing medical physics practice guidelines will be reviewed for the purpose of revision or renewal, as appropriate, on their fifth anniversary or sooner. Each medical physics practice guideline represents a policy statement by the AAPM, has undergone a thorough consensus process in which it has been subjected to extensive review, and requires the approval of the Professional Council. The medical physics practice guidelines recognize that the safe and effective use of diagnostic and therapeutic radiology requires specific training, skills, and techniques, as described in each document. Reproduction or modification of the published practice guidelines and technical standards by those entities not providing these services is not authorized. The following terms are used in the AAPM practice guidelines: (1) Must and Must Not: Used to indicate that adherence to the recommendation is considered necessary to conform to this practice guideline. (2) Should and Should Not: Used to indicate a prudent practice to which exceptions may occasionally be made in appropriate circumstances.

The MedPhys match survey: Search criteria and advice for programs and applicants.

PURPOSE: The purpose of this study was to gauge the experiences of applicants and program directors (PDs) in the Medical Physics (MedPhys) Match (MPM) and to determine the most important characteristics and factors that influence decision-making for applicants and programs when screening, interviewing, and ranking in the MPM. Opinions were also solicited from applicants and PDs on the status of medical physics residencies and the selection process, such as the availability of residency positions and satisfaction with the match process. METHODS: A survey was sent to all applicants registered for the 2015-2018 MPM and to all PDs registered for the 2015-2017 MPM. Survey questions asked about the pre-interview screening, interview, and ranking stages of the residency match process. Survey data were analyzed using graphical methods and spreadsheet tools. RESULTS: An increasing percentage of applicants are female and/or hold a PhD as their highest degree. The over all number of interview invitations per applicant has increased, leading some applicants to decline interviews with the top reasons being cost of travel and scheduling conflicts. The top considerations for applicants in ranking programs were residency program/institution reputation, program structure/organization, and facilities/equipment available. The primary considerations identified by PDs for ranking applicants included impressions from the interview, personality fit, and clinical potential. While two-thirds of applicants agreed or strongly agreed with the statement that a residency position was difficult to obtain, roughly one-third of PDs agree that the current residency placement rate is a problem. CONCLUSION: Four years of survey data on the experiences of applicants and PDs participating in the MPM is useful to future participants navigating the residency match system. It is hoped that the data will be helpful to inform improvements and to enhance understanding of the residency match system and how it shapes our profession.

School-Age Children Adapt the Dynamics of Lexical Competition in Suboptimal Listening Conditions.

Although the ability to understand speech in adverse listening conditions is paramount for effective communication across the life span, little is understood about how this critical processing skill develops. This study asks how the dynamics of spoken word recognition (i.e., lexical access and competition) change during soft speech in 8- to 11-year-olds (n = 26). Lexical competition and access for speech at lower intensity levels was measured using eye-tracking and the visual world paradigm. Overall the results suggest that soft speech influences the magnitude and timing of lexical access and competition. These results suggest that lexical competition is a cognitive process that can be adapted in the school-age years to help cope with increased uncertainty due to alterations in the speech signal.

Visual and haptic responses as measures of word comprehension and speed of processing in toddlers: Relative predictive utility.

Early vocabulary knowledge and speed of word processing are important foundational skills for the development of preschool and school-age language and cognition. However, the variance in outcomes accounted for by parent-reported receptive or expressive vocabulary is generally modest. Recent research suggests that directly assessed, decontextualized vocabulary predicts developmental outcomes, including general language ability and kindergarten readiness, accounting for additional variance above and beyond parent-reported vocabulary. The current research extends this finding by exploring prediction from both decontextualized vocabulary and speed of word processing at 2 years of age to vocabulary during the preschool period. At age 2, children completed a two-alternative forced-choice task that yielded a measure of decontextualized vocabulary (number of correct touch responses) and two measures of speed of processing: latency to fixate the target (visual response latency) and latency to touch (haptic response latency). Results reveal that age 2 vocabulary and visual response latency, but not haptic response latency, independently predict vocabulary at ages 3 and 4. Furthermore, only decontextualized vocabulary remains a significant predictor when controlling for speed of processing, but not vice versa. This suggests that the number of early, stable word-referent associations and the efficiency with which these are processed are important to vocabulary outcomes. However, it also suggests that decontextualized vocabulary may be a more robust unique predictor of downstream outcomes.

Cognitive processes underlying spoken word recognition during soft speech.

In two eye-tracking experiments using the Visual World Paradigm, we examined how listeners recognize words when faced with speech at lower intensities (40, 50, and 65 dBA). After hearing the target word, participants (n = 32) clicked the corresponding picture from a display of four images - a target (e.g., money), a cohort competitor (e.g., mother), a rhyme competitor (e.g., honey) and an unrelated item (e.g., whistle) - while their eye-movements were tracked. For slightly soft speech (50 dBA), listeners demonstrated an increase in cohort activation, whereas for rhyme competitors, activation started later and was sustained longer in processing. For very soft speech (40 dBA), listeners waited until later in processing to activate potential words, as illustrated by a decrease in activation for cohorts, and an increase in activation for rhymes. Further, the extent to which words were considered depended on word length (mono- vs. bi-syllabic words), and speech-extrinsic factors such as the surrounding listening environment. These results advance current theories of spoken word recognition by considering a range of speech levels more typical of everyday listening environments. From an applied perspective, these results motivate models of how individuals who are hard of hearing approach the task of recognizing spoken words.

The Current State of Physics Plan Review Training in Medical Physics Residency Programs in North America.

PURPOSE: This study aimed to identify the current state of residency training in physics plan reviews. METHODS AND MATERIALS: A voluntary, anonymous survey was sent to all program directors of accredited therapeutic medical physics residency programs in North America. Survey questions were developed to determine whether and how residents are trained in physics plan reviews. Survey questions were developed using expert validation and cognitive pretesting. RESULTS: Using a prospectively approved study (COMIRB 18-1073), responses were collected from 70 program directors, representing a 70% response rate. All respondents (100%) designated patient safety to be the purpose of physics plan reviews. Of the respondents, 94% indicated that physicists should first receive training in physics plan reviews while in a residency program. The vast majority of respondents (99%) provide training to residents in physics plan reviews. Although 57 programs (81% of respondents) have residents perform physics plan reviews as part of clinical practice (with varying levels of independence), 13 programs (19% of respondents) do not. The majority of respondents use the following training methods: observe staff physicists (96%), perform supervised reviews on actual patients for training or clinical practice (93%), use a checklist (80%), and read reference materials (62%). Although simulation plans with embedded errors would be implemented by 71% of respondents, they are currently used in only 19% of programs. CONCLUSIONS: The present study is the first to characterize chart-check teaching practices in medical physics residency programs. The vast majority of programs currently train residents in physics plan reviews. The most common teaching methods are observing and performing physics plan reviews, but there is variability in the level of resident involvement in clinical practice for physics plan reviews. There is room for the field to consider advancing current training methods, which is especially important given the critical roles that physics plan reviews have with regard to patient safety.

Bridging the Radiation Oncology and Diagnostic Radiology Communication Gap: A Survey to Determine Usefulness and Optimal Presentation of Radiotherapy Treatment Plans for Radiologists.

RATIONALE AND OBJECTIVES: We hypothesized that providing visual-spatial information to radiologists on where radiation has been delivered in an easily accessible way may improve the accuracy of image interpretation and thereby improve quality of patient care. We present a national representation of radiologists' opinions regarding the usefulness and optimal approach for implementing a system to promote access to radiotherapy (RT) plans. METHODS: An anonymous survey was sent to the members of the Association of University Radiologists. Descriptive statistics were performed. RESULTS: Questionnaires were returned by 95 of 1383 members. Demographics comprised of 76% attendings with 94% practicing within an academic setting. Only 40% of radiologists reported that they knew most of the time whether a patient has received RT in the field scanned. A large majority of respondents (88%) felt that a history of prior radiation in a cancer patient was at least an occasional barrier that affected the ability to interpret imaging findings in a clinically useful way. The following types of information was considered helpful when interpreting a scan: screenshots of the radiation plan (85%), scrollable DICOM data on planning CT showing delivered RT dose lines (54%), and written text RT treatment summary (47%). Nearly all (89%) desired DICOM data within the clinical radiology Picture Archiving and Communication System system. Radiologists expected the ease of accessibility to RT plans to result in increased efficiency (76%) and accuracy (88%). CONCLUSION: Diagnostic radiologists desire improved access and integration of radiotherapy plans into the diagnostic radiology clinical workup in the form of visual-spatial data.

The organization of words and environmental sounds in the second year: Behavioral and electrophysiological evidence.

The majority of research examining early auditory-semantic processing and organization is based on studies of meaningful relations between words and referents. However, a thorough investigation into the fundamental relation between acoustic signals and meaning requires an understanding of how meaning is associated with both lexical and non-lexical sounds. Indeed, it is unknown how meaningful auditory information that is not lexical (e.g., environmental sounds) is processed and organized in the young brain. To capture the structure of semantic organization for words and environmental sounds, we record event-related potentials as 20-month-olds view images of common nouns (e.g., dog) while hearing words or environmental sounds that match the picture (e.g., "dog" or barking), that are within-category violations (e.g., "cat" or meowing), or that are between-category violations (e.g., "pen" or scribbling). Results show both words and environmental sounds exhibit larger negative amplitudes to between-category violations relative to matches. Unlike words, which show a greater negative response early and consistently to within-category violations, such an effect for environmental sounds occurs late in semantic processing. Thus, as in adults, the young brain represents semantic relations between words and between environmental sounds, though it more readily differentiates semantically similar words compared to environmental sounds.