AuDacity 2019 — Agenda


November 14-16, 2019
Gaylord National Resort & Conference Center
National Harbor, Maryland

 

The Academy of Doctors of Audiology is approved by the American Academy of Audiology to offer Academy CEUs for this activity. The program is worth a maximum of 1.65 CEUs/1.2 ABA Tier 1 CEUs. Academy approval of this continuing education activity is based on course content only and does not imply endorsement of course content, specific products, or clinical procedure, or adherence of the event to the Academy's Code of Ethics. Any views that are presented are those of the presenter/CE Provider and not necessarily of the American Academy of Audiology.

 

Course Descriptions

Thursday, November 14, 2019

5:30 PM - 7:00 PM

Opening Reception in Exhibit Hall

Friday, November 15, 2019

7:00 AM - 8:00 AM

Breakfast in the Exhibit Hall

Prince George’s Hall D

8:00 AM - 8:30 AM

Welcome & President's Address

Woodrow Wilson Ballroom BCD

Speakers:

8:30 AM - 9:30 AM

Keynote Presentation - Hearing Loss and Dementia

This session will discuss the interrelationship between hearing loss and dementia in various clinical and research settings.

Dr. Esther Oh is an Associate Professor of Medicine, Psychiatry and Behavioral Sciences and Pathology at the Johns Hopkins University School of Medicine. Her area of clinical expertise is the evaluation and management of memory disorders. She has extensive experience in evaluating memory disorders in older adults with multiple chronic diseases, and takes an integrative approach in the treatment of memory disorders. Dr. Oh also serves as the associate director of the Johns Hopkins Memory and Alzheimer’s Treatment Center.

Dr. Oh’s research is primarily focused on Alzheimer’s disease and related disorders. Her current projects include: development of biomarkers for detecting early stages of Alzheimer’s disease; understanding the interrelationship between delirium and Alzheimer’s disease; cognitive changes after surgery; and understanding the role of sensory problems (hearing and vestibular function) in Alzheimer’s disease. Dr. Oh is certified in geriatrics and internal medicine by the American Board of Internal Medicine.

Woodrow Wilson Ballroom BCD

Speakers:

9:30 AM - 10:00 AM

Break in the Exhibit Hall

Prince George’s Hall D

10:00 AM - 11:30 AM

General Session - Providing Exceptional Patient Experiences to the Aging Boomers and Gen X

The population is aging and again the Baby Boomers are going to impact almost all aspects of our society as they move through their 60’s, 70’s, and 80’s. The more you know about this population segment, often called the “Me Generation,” the better you will be able to provide them with an exceptional patient experience and enable them to get hearing health. It’s also important to have an eye on the next generation that follows, the X-Generation. This generation may not be primary users, but they are or soon will be caregivers and influencers to their Baby Boomer parents. This session will take a closer look at these two generations and specifically at the patient journey through the lens of the Baby Boomers.

Woodrow Wilson Ballroom BCD

Speakers:

11:30 AM - 1:00 PM

Lunch in Exhibit Hall

Prince George’s Hall D

1:00 PM - 2:00 PM

Keynote Presentation - Marketing to the Active Aging Consumer

Marketers are missing the largest business opportunity by virtually ignoring active aging consumers who control over 70% of the wealth and account for 40-50% of consumer spending across most categories. Yet marketers are only spending 5-10% of their budgets to market to this group, choosing instead to spend 5 times more against the younger millennial group who account for less than 20% of all consumer spending. In his presentation, Jeff Weiss will highlight the opportunity in targeting active aging consumers, defining who they are and what makes them tick. He will reveal the Dirty Dozen Myths associated with aging and crush the myths and break the stigma and stereotypes attached to older consumers. Finally, he will share advice and practical tips on how to best find, reach and engage the Active Aging consumer.

Woodrow Wilson Ballroom BCD

Speakers:

2:00 PM - 3:00 PM

General Session - Living Longer and Living Better: Technology and Wellbeing for an Aging Population

In this session, participants will learn about how increased longevity has resulted in changing demographics in the U.S., creating a new longevity economy and a consumer market of older adults whose demands and expectations around their aging differ from those of previous generations.

Woodrow Wilson Ballroom BCD

Speakers:

3:00 PM - 3:30 PM

Break

Prince George’s Hall D

3:30 PM - 5:00 PM

General Session - The Wellness-Illness Continuum: Serving Older Adults at Every Point Along the Way

Many older adults experience multiple chronic conditions as they age. Learning to manage these conditions can be a real challenge for both the patient and the health care providers that care for them. This session will cover the varying degrees of health and well being of the older adult population, the types of chronic conditions they face and the options for treatment and care.

Woodrow Wilson Ballroom BCD

Speakers:

5:15 PM - 6:15 PM

ADA Member Meeting

Woodrow Wilson Ballroom BCD

6:15 PM - 8:00 PM

Special Event in Exhibit Hall

Join attendees in the ADA Marketplace for food and fun, network with your colleagues, and visit with the exhibitors, to discover innovative solutions that you can put into practice in your practice!

Prince George’s Hall D

Saturday, November 16, 2019

7:00 AM - 8:00 AM

Breakfast in the Exhibit Hall

Prince George’s Hall D

7:00 AM - 8:00 AM

Mastermind Networking Breakfast (active and interested Mastermind group participants only)

Prince George’s Hall D

8:00 AM - 9:30 AM

Managing Patient Anxiety, Ambivalence and Lack of Awareness of Hearing Loss: An Audiology/Psychology Collaboration, Part 1 [TIER1]

Audiologists are very good at “content counseling” where we deal with technical aspects of care that are information based. The mistake audiologists make in most situations is that they see their task as just supplying cognitive information—hard cold facts and descriptions. They want to be Dr. Informative. There is a lack of comfort and experience in managing affect or feeling statements. Feelings are the major factor that make patients feel connected to us. Patients respond positively to having their feelings acknowledged and validated, as it reflects their affective experience in relation to their worlds.

This session will address the major psychological dynamics of hearing care. Motivational Interviewing (MI) and Listen, Empathize, Agree and Partner (L.E.A.P.) are evidence-based counseling strategies to manage a variety of health problems such as smoking cessation, drug/alcohol addiction, and psychiatric disorders. Participants will receive “hands-on” training in MI and L.E.A.P.

Woodrow Wilson Ballroom B

Speakers:

 

Understanding Financial Success in Your Practice: Managed Care vs. Private Pay Patients

For today’s practice, industry adoption of managed care, change in patient sources, and the effects of third-party payers and the Internet can influence a practice’s financials. This session will explore why it is important to evaluate and value your practice annually and the steps you can take to achieve financial success. When you are armed with the right strategies within managed care, you have the ability to create value in today’s dynamic market.

Woodrow Wilson Ballroom A

Speakers:

 

Delight your Patients & Differentiate your Practice: Instant Custom Molds Hands-on Workshop

Don’t settle for power domes. Offer your patients same-day custom molds that you can make in-house in under 5 minutes. Have you ever had a patient with hearing loss so significant that they can’t be fit with an open dome, yet you want to fit them on the same day? Do any of your patients come in with a custom product that needs to go in for repair, and you’d like to give them a loaner so they can keep hearing while their device is with the manufacturer? Or do you ever have that awkward conversation with a patient who returns where you still have to charge them $150 for the earmolds?

These are just a few of the reasons why it’s important to be able to make a good-fitting earmold on the spot. In this workshop, we’ll teach you everything you need to know to be able to implement this technique in your own practice right away. Your patients will love them, and it will really differentiate your practice from the competition.

Woodrow Wilson Ballroom C

Speakers:

 

INNOVATION SESSION: A Changing Standard of Care: Incorporating Treatment with Implantable Hearing Devices in a Private Practice Setting, Part 1 [TIER 1]

With changes to candidacy, technology, patient profiles, and appointment duration, it is now feasible to expand the services offered in a private practice setting to include cochlear implants. Becoming part of a medical network can help to differentiate and elevate your practice. This course will include a panel discussion to review the history, trends, and experience of those involved in such an expanded continuum of care.

Woodrow Wilson Ballroom D

Speakers:

9:30 AM - 9:45 AM

Break in the Exhibit Hall

Prince George’s Hall D

9:45 AM - 11:15 AM

Managing Patient Anxiety, Ambivalence and Lack of Awareness of Hearing Loss: An Audiology/Psychology Collaboration, Part 2 [TIER 1]

Audiologists are very good at “content counseling” where we deal with technical aspects of care that are information based. The mistake audiologists make in most situations is that they see their task as just supplying cognitive information—hard cold facts and descriptions. They want to be Dr. Informative. There is a lack of comfort and experience in managing affect or feeling statements. Feelings are the major factor that make patients feel connected to us. Patients respond positively to having their feelings acknowledged and validated, as it reflects their affective experience in relation to their worlds.

This session will address the major psychological dynamics of hearing care. Motivational Interviewing (MI) and Listen, Empathize, Agree and Partner (L.E.A.P.) are evidence-based counseling strategies to manage a variety of health problems such as smoking cessation, drug/alcohol addiction, and psychiatric disorders. Participants will receive “hands-on” training in MI and L.E.A.P.

Woodrow Wilson B

Speakers:

 

Moving the Needle: The Process of Creating Audiology State Licensure Laws for a New Millennium

Audiology licensure, in most states, reflects model language that is over 25 years old. This workshop will provide a template for how to approach the process of licensure modification in the US. Practical, step by step guidance will be outlined.

Woodrow Wilson A

Speakers:

 

Creating an Effective Physician Outreach Marketing Process

This 90-minute workshop style session will include an overview of creating and implementing an effective outreach marketing process. Attendees will also attend three separate stations within the session on developing marketing materials, creating a marketing plan, and interacting with physicians and other health care professionals. Each station will provide opportunities to ask questions and directly interact with the facilitators.

Woodrow Wilson C

Speakers:

 

INNOVATION SESSION: A Changing Standard of Care: Incorporating Treatment with Implantable Hearing Devices in a Private Practice Setting, Part 2 [TIER 1]

With changes to candidacy, technology, patient profiles, and appointment duration, it is now feasible to expand the services offered in a private practice setting to include cochlear implants. Becoming part of a medical network can help to differentiate and elevate your practice. This course will include a panel discussion to review the history, trends, and experience of those involved in such an expanded continuum of care.

Woodrow Wilson D

Speakers:

11:15 AM - 12:30 PM

Lunch in Exhibit Hall

Prince George’s Hall D

12:30 PM - 1:30 PM

INNOVATION SESSION: Latest Advances in Audiological Artificial Intelligence, Part 1: Rise of the Audiological Machines [TIER 1]

Audiologic tasks completed within one second of thought may be automated with artificial intelligence now or in the near future. There have already been attempts to automate audiometry and hearing instrument fitting. From machine learning to natural language processing, most advances like these are unlikely to replace audiologists, and some may help us thrive amid the rise of the machines.

Woodrow Wilson B

Speakers:

 

Direct-to-Consumer Healthcare Trends: Maintaining Revenue and Identifying Value Proposition

This presentation focuses on the shifting trends in healthcare, in general, from a traditional model to a retail model with the same/improved expected outcomes. In addition, we will discuss how these innovations influence value propositions for practices. Examples in other markets, and their corresponding professions, include: Warby Parker for optometry, Invisalign for dentistry, and, now, direct-to-consumer (DTC) for hearing health. The presentation opens with an overview of the three distinct service categories with revenue opportunities associated with DTC devices, followed by a discussion and examples on how to employ these opportunities in a clinical setting. Next, we provide a workflow model that illustrates revenue streams in an existing practice. Audience participants will have the opportunity to develop a conceptual model for a hypothetical practice using the categories discussed.

Woodrow Wilson C

Speakers:

 

Precepting: What Practice Owners Need to Know

Members of the Student Academy of Doctors of Audiology will host a panel session on Precepting from the perspective of a student extern. Our panelists will discuss what they look for when applying for externships, their educational needs, and the current trends in audiology education and supervision.

Woodrow Wilson A

Speakers:

  • Jennifer Boakye, A.T. Still University
  • Leah Demko, The Ohio State University
  • Jared Poland, University of Texas at Dallas
  • Kristin Johnson, University of Illinois
  • Kristen Nashert, University of Oklahoma
  • Lea Sherwood, Pacific University
  • Kate Witham, Gallaudet University

 

Collaborative Audiology and Pharmacy Impact on Patient Care

This session will focus on the effects audiology and pharmacy practices have on one another. Specific topics will include ototoxic medications, drug induced hearing changes and polypharmacy in the geriatric patient population. In addition, this learning activity will highlight the professional collaboration between audiology and pharmacy and their positive impact on patient outcomes.

Woodrow Wilson D

Speakers:

1:30 PM - 1:40 PM

Break

Woodrow Wilson Foyer

1:40 PM - 2:40 PM

INNOVATION SESSION: Latest Advances in Audiological Artificial Intelligence, Part 2: Real Life Hearing - Implications and Opportunities for AI [TIER 1]

As audiologists, we have long focused our efforts on the auditory environments that our patients encounter, and on optimizing performance and satisfaction by manipulating hearing instrument parameters following patient reports of performance in the real world. A novel perspective – Real Life Hearing – now offers us a comprehensive framework that encompasses these ‘traditional’ elements of hearing (Acoustic Scene, Auditory Processing, and Auditory Cognition) as well as incorporates a vital, but until recently overlooked element, that of Evaluation and Behavior. This additional variable allows us to carefully consider our patient’s listening intention. Our ability to align device performance with intention is crucial for satisfaction and consistent use of hearing solutions. This presentation will examine what is known regarding each of these four elements as well as discuss applying that information for maximizing fitting efficiency and success.

Woodrow Wilson B

Speakers:

 

Using a Subscription Model to Increase Treatment & Loyalty

The hearing aid industry is experiencing changes with the introduction of many new market forces, including over the counter (OTC) hearing aids, managed care contracts, and big box retailers. The traditional marketing of hearing aids using a bundled product/service model is being challenged. Do these market forces warrant a change in how we offer our products and services? This session will look at a marketing concept to offer a long-term continuum of care that is comprehensive, convenient, and provides your patient with automatic technology upgrades to keep your clinic profitable and competitive. Most importantly, it will keep your patient loyal and coming back to you for their personalized hearing health care.

Woodrow Wilson A

Speakers:

 

Embrace the Change: a How-To Guide for Dispensing PSAPs in a Clinic

Personal Sound Amplification Products (PSAPs) have been a source of disruption in the profession of Audiology. With constantly evolving technology inching closer to replicating or exceeding hearing aid technology, audiologists must now evaluate the place that PSAPs have in their clinical practice. In this presentation, we will discuss how to begin dispensing PSAPs based on the experience of doing so in a large hospital-based audiology practice. We will discuss how to evaluate and select PSAPS, how to incorporate PSAPs into normal clinic flow, and how to evaluate the effectiveness of the selected intervention. We will also examine approximately one year of outcome measures obtained from patients who purchased PSAPs.

Woodrow Wilson C

Speakers:

 

Adding Tinnitus Management to your Clinical Practice: Evidence-based Recommendations for Success

Tinnitus impacts 45 million Americans, with 12 million seeking care. Many audiologists contemplate incorporating tinnitus into their clinical practice, although the actual process of evaluating peer-reviewed publications and vetting manufacturer white papers can be quite daunting and time-consuming. The purpose of this presentation is to provide the clinical audiologist with a foundational understanding and framework of potential strategies to successfully implement a tinnitus program into their clinical practice, and possible pitfalls.

Woodrow Wilson D

Speakers:

2:40 PM - 2:50 PM

Break

Woodrow Wilson Foyer

2:50 PM - 3:50 PM

INNOVATION SESSION: Latest Advances in Audiological Artificial Intelligence, Part 3: The Latest AI Advances in Patient Health and Well Being [TIER 1]

As the technology advances, patient care will advance and provide options for health care monitoring at all levels of care. Artificial intelligence has advanced health care across the spectrum, including advances in hearing aid technology. This course will cover the latest available AI technology, including a discussion of the ability of these devices to track other health patterns, identify care givers in the event of a fall, and even translate languages.

Woodrow Wilson B

Speakers:

 

Managing Threats and Opportunities in Today's Audiology Private Practice

Change can be stressful, but this presentation is intended to fill you with tools, hope, and optimism as we address the audiology private practice future. We are seeing billing and reimbursement changes, as well as huge marketing trend shifts—marketing alone has changed more in the past five years than it has in the previous 50 years. The way we bill our patients is also changing with the influx of third-party administrators and online hearing aid sales. Audiology practices need to change to stay current and competitive.

Woodrow Wilson C

Speakers:

 

A Critical Review of Audiology Employment and Provision of Hearing Healthcare Services

The profession of audiology is at a critical crossroads in its evolution. The U.S. population that could benefit from audiological services and treatment is expected to increase markedly over the next three decades, yet the number of audiologists available to provide services is not expected to increase. In this presentation, we assess the disparity between demand for services and the supply of available audiologists using various economic and public health models. The aim of this presentation is to provide audiology practice owners a perspective of those factors that lend to the profession’s footprint within the healthcare arena, and other factors that may limit, or possibly extinguish, our professional identity.

Woodrow Wilson A

Speakers:

 

Vestibular Function in Children with Hearing Loss

There are over 500 heritable conditions that cause audio-vestibular dysfunction, many of which have a greater expressivity in vestibular loss. All too often, balance function in children is overlooked as we focus on the identification and intervention for hearing loss. This presentation will review best practices for identification and management of vestibular dysfunction in infants as young as three months of age as well as the role of cochlear implants and future developments of combined cochlear-vestibular implants.

Woodrow Wilson D

Speakers:

3:50 PM - 4:00 PM

Break

Woodrow Wilson Foyer

4:00 PM - 5:30 PM

Prepare Your Business for Maximum Sales Value

You’ve worked hard to create and grow your business. When it comes time to sell, will you be prepared to position your business for maximum value? Or will you leave money on the table with less than desirable terms? This talk will give an overview of strategies that can be used to position your practice for maximum value.

Woodrow Wilson B

Speakers:

 

INNOVATION SESSION: Telehearing Care for Today's Success

Telehealth is a current buzz-word in all realms of the healthcare community and is gaining traction as fast as the technology and legislation will allow. Expansion into hearing healthcare is no exception. While there are debates on the pros and cons of this method of service delivery, telehealth is not going away. There are a variety of applications and arrangements of using telehealth in hearing care, from simple to complex; however, very few exist where the provider completes synchronous services in real time remotely to a patient located at a distant site. We will review the successful outcomes of this modern service model currently active in a variety of settings, complete with demonstration video and clinical outcomes. Implementation steps and patient relationship-building techniques will be reviewed. Ample time will be included to address questions to a participating audiologist currently offering TeleHearing Care in practice.

Woodrow Wilson C

Speakers:


 

Messy Brilliance: Work-Life Balance and Self-Care for Audiologists

Have you noticed an increase in your daily stress levels over the past couple of years? It seems that being busy is the new modern-day epidemic. We are constantly trying to live life, but often forget to take care of ourselves. We suffer in silence, struggling with exhaustion and being overwhelmed while feeling unfulfilled. Stress, when unmanaged, can impact your relationships and greatly affect your ability to enjoy life. When it becomes your way of being in the world, you reduce the ability to respond with clarity and instead react from a place of disconnect and fear. In this course, you’ll learn practical tools to reduce stress and tension and move forward feeling empowered and connected.

Woodrow Wilson A

Speakers:

 

Sky Marvel and RogerDirect: Bringing kids ‘Love at First Sound’ experiences and helping them more fully experience their world

This course explores the latest hearing aid and remote microphone technologies and any associated fitting practice updates. Use cases will illustrate improved outcomes for pediatric patients. Childhood development phases and the changing needs of pediatric patients transitioning to their teenage years will provide context for these topics.

Woodrow Wilson D

Speakers:

Saturday, November 16, 2019 — STUDENT PROGRAM

8:00 AM - 9:30 AM

Exceptional Hearing Aid Fittings with a Patient-Centered Focus (Part 1)

This session will cover innovative technology and the importance of a strong recommendation and how to overcome objections. Additionally, students will participate in various hands-on activities.

Baltimore 5

9:45 AM - 11:15 AM

Exceptional Hearing Aid Fittings with a Patient-Centered Focus (Part 2)

This session will cover innovative technology and the importance of a strong recommendation and how to overcome objections. Additionally, students will participate in various hands-on activities.

Baltimore 5

12:30 PM - 1:30 PM

Owning a General Audiologist Title: How to Embrace Practicing Full Scope in Private Practice

Many of us have been led to believe that to be good audiologists and business owners, we need to specialize in only a few areas. Being an “expert” sounds better, right? But if we look to other clinical doctorate professionals such as dentists, optometrists, and physical therapists, we can see how being a general audiologist could be, and maybe should be, the norm. As the baby boomers continue to age, the shortage of audiologists will only become a bigger problem. This is what our communities need, but it also takes a community to pull off. Instead of losing focus on what you are good at, as you expand your knowledge and begin to become a general audiologist, you quickly start to become better at the areas you feel more specialized in too!

Baltimore 5

Speakers:

1:40 PM - 2:40 PM

Current HIPAA Guidelines for Audiology

The Health Information Portability and Acccountability Act (HIPAA) of 1996 was created to develop regulations protecting the privacy and security of certain health information. Currently, there is a lot of confusion amongst professionals about how to appropriately use the Protected Health Information (PHI) of our patients. This course will go through some of the basic fundamentals of HIPAA, the current regulations, and the penalties, presented specifically for audiologists.

Baltimore 5

Speakers:

2:50 PM - 3:50 PM

A Successful Path to Ownership, Partnership and Private Practice

In this session, students will learn the steps and pitfalls to successfully become a private practice owner or partner.

Baltimore 5

Speakers:

4:00 PM - 5:30 PM

Custom Molds Student Version

Students will learn how to make same-day custom molds that you can make in-house in under 5 minutes. In this workshop, we’ll teach you everything you need to know to be able to implement this technique in your own practice right away.

Baltimore 5

Speakers:

Sunday, November 17, 2019 — WORKSHOPS

8:00 AM - 11:15 AM

Practice Accreditation Workshop

This session will describe the process of applying for the new practice accreditation through ADA. Participants will learn how to create an accreditation plan for their practice and discuss the key factors in the accreditation audit process.

Baltimore 2

8:00 AM - 5:00 PM

CAOHC – The Professional Supervisor of the Audiometric Monitoring Program© (PS/A)

This is an intermediate-level, full-day course. It emphasizes the real-world application of audiology expertise as encountered in occupational settings. Lectures review the current literature and practice guidelines. Instructors present employee case studies for participant problem-solving, critical thinking and small-group discussion. Case presentations discuss PS responsibilities, guidelines for managing problem audiograms and determination of work-relatedness.

Magnolia 1

Speakers:

  • D. Bruce Kirchner, M.D. M.P.H. CPS/A
  • Laurie Wells, Au.D., F.A.A.A., CPS/A

8:30 AM - 11:15 AM

The Ins and Outs of Cerumen Management, Part 1

The time is now to expand your patient services with procedures that are part of your scope of practice. Do you wish you could feel more comfortable and confident working in the ear canal? Do you want to sharpen your skills of cerumen and foreign body removal? Are you a new Doctor of Audiology that would like further training or to learn proper techniques to perform cerumen management? This educational and practical workshop will cover the anatomy and physiology of the outer ear, conditions of the ear canal, otoscopic examinations, properties and characteristics of cerumen, methods of cerumen management, and related issues such as liability, reimbursement, and state licensure. This is one of the only courses in the country that offers approximately two hours for workshop participants to actually use a variety of cerumen removal instruments and equipment. Join us to learn best practices for this important part of audiology services.

Baltimore 1

Speakers:

8:30 AM - 5:00 PM

American Institute of Balance – Dizziness is Good Business: Seven Rules of Building a Successful Diagnostic Practice

Dizziness, vertigo and falls are among the leading complaints of all patients and the #1 complaint of the largest growing segment of the population, individuals 65 years of age and older. Audiologists have all too often abdicated balance testing due to lowered reimbursement, the obstacles of equipment cost and difficulty developing referrals.

Magnolia 2

Speakers:

11:15 AM - 12:00 PM

Lunch (Cerumen Class Only)

12:00 PM - 4:00 PM

The Ins and Outs of Cerumen Management, Part 2

The time is now to expand your patient services with procedures that are part of your scope of practice. Do you wish you could feel more comfortable and confident working in the ear canal? Do you want to sharpen your skills of cerumen and foreign body removal? Are you a new Doctor of Audiology that would like further training or to learn proper techniques to perform cerumen management? This educational and practical workshop will cover the anatomy and physiology of the outer ear, conditions of the ear canal, otoscopic examinations, properties and characteristics of cerumen, methods of cerumen management, and related issues such as liability, reimbursement, and state licensure. This is one of the only courses in the country that offers approximately two hours for workshop participants to actually use a variety of cerumen removal instruments and equipment. Join us to learn best practices for this important part of audiology services.

Baltimore 1

Speakers: