Добірка наукової літератури з теми "Audio effects modelling"

Recent advancements in deep learning have the potential to transform the process of writing and creating music. Models that have the potential to capture and analyze higher-level representations of music and audio can serve to change the field of digital signal processing. In this statement, I propose a set of Music+AI methods that serves to assist with the writing of and melodies, modelling and transferring of timbres, applying a wide variety of audio effects, including research into experimental audio effects, and production of audio samples using style transfers. Writing and producing music is a tedious task that is notably difficult to become proficient in, as many tools to create music both cost sums money and require long-term commitments to study. An all-encompassing framework for music processing would make the process much more accessible and simple and would allow for human art to work alongside technology to advance.

A steerable parametric array loudspeaker (PAL) can electronically steer highly directional audio beams in the desired direction. The challenge of modelling a steerable PAL is to obtain the audio sound pressure in both near and far fields with a low computational load. To address this issue, an extension of the spherical wave expansion is proposed in this paper. The steerable velocity profile on the radiation surface is expanded as Zernike polynomials which are an orthogonal and form a complete set over a unit circle. An expression for the radiated audio sound is then obtained using a superposition of Zernike modes. Compared to the existing methods, the proposed expansion is computationally efficient and provides a rigorous transformation of the quasilinear solution of the Westervelt equation without paraxial approximations. The proposed expansion is further extended to accommodate local effects by using an algebraic correction to the Westervelt equation. Numerical results for steering single and dual beams are presented and discussed. It is shown that the single beam can be steered in the desired direction in both near and far fields. However, dual beams cannot be well separated in the near field, which cannot be predicted by the existing far field models.

The purpose of the research is to analyze the phenomenon of human perception of the combination of film images in varying space and time and with different actions. To determine the role of audio and video combination: soundtrack, counterpoint; to trace the parallels between the structure of musical works and music notation with composition, as well as the system of editing audiovisual works; to outline the main editing transitions and special effects, to note the feasibility of their use in modern audiovisual production. The research methodology is based on the following scientific methods: theoretical (analysis of physiological and psychological factors of the viewer's perception of an audiovisual work, analysis of outstanding examples of world cinema); comparative (drawing parallels between the language of cinema and music); practical (modelling specific examples of combining several frames). Scientific novelty. For the first time, the authors analyze the peculiarities of editing in contemporary audiovisual production, reveal the specifics of special effects and transitions, draw parallels between the levels of editing and the language of musical works; establish some details of the phenomenon of perception of editing at the level of psychology and everyday life and define the main criteria for the quality of editing transitions and effects. Conclusions. The peculiarities of montage have been identified, and the fact of perception of different moving images collision at the subconscious level in an audiovisual work has been analyzed. It is proved that pictures that are not united by space, time and action can create a coherent associative story. The role of audio and video combination has been defined – from synthesis with an amplifying effect to collision and creation of counterpoint. Parallels between musical works and the composition of an audiovisual work have been drawn. The main transitions and effects, as well as the conditions for their creation in modern audiovisual production, have been identified.

The emotions experienced by primary school students have both positive and negative effects on learning processes. Thus, to better understand learning processes, research should consider emotions during class. Standard survey-based methods, such as self-reports, are limited in terms of capturing the detailed trajectories of primary school children’s emotions, as their abilities of self-reporting are developing and still limited. Emotions can also be tracked by capturing emotional responses as they occur e.g. from physiological reaction measured with sensor wristbands. This technology generates an emotional responsestypology based on continuously captured physiological data, such as skin conductivity and skin temperature. However, such measurement methods need to be validated before being used. The present study thus attempted to validate this instrument with primary school students. We used the BM Sensor Wristband technology, as its emotional response typology is based on the categorical emotion and homeostasis approach. In our research, we focus on the emotional responses that can be distinguished by the BM Typology and that can influence learning processes. These emotional responses are: “joy”, “curiosity”, “attention”, “fear”, “anger” and “passivity”. Therefore, we induced emotional responses in primary school children through specifically developed audio-visual stimuli. Using logistic mixed effects modelling, we investigated the occurrence of opposing reactions. We observed that primary school children’s reactions to audio-visual stimuli could be differentiated. We conclude that primary school children’s emotional responses, such as “joy”, “curiosity”, “attention”, “fear”, “anger” and “passivity”, can be accurately measured by evaluating physiological data.

It is well established that physical activity leads to numerous health, cognitive, and psychological benefits. However, to date, very few studies have investigated the impact of physical activity on multisensory perception, that is, the brain’s capacity to integrate information across sensory modalities. Furthermore, it is unknown what level of long-term physical activity is associated with multisensory integration in adults. We explored the relationship between multisensory integration and a ten-year physical activity trajectory in 2,974 adults aged 50+ from The Irish Longitudinal Study on Ageing by measuring susceptibility to the Sound Induced Flash Illusion (SIFI) at multiple audio-visual temporal asynchronies. Physical activity was measured using the International Physical Activity Questionnaire (IPAQ-SF) at 2 years intervals over ten years. We used latent class trajectory modelling to identify latent growth classes of individuals following a similar trajectory of physical activity over time. We analysed the association of this trajectory with performance accuracy to the illusion trials of the SIFI task with generalized logistic mixed effects regression models, adjusted for several covariates. Results showed that more precise integration (i.e., lower SIFI susceptibility with larger temporal asynchronies) was associated with a higher level of sustained physical activity across ten years. Although the use of self-reported physical activity and a short version of the SIFI task limit our conclusions to some extent, nonetheless, the results suggest that sustained physical activity is associated with more precise multisensory integration, which in turn is linked to better balance and a lower risk of falling in older adults.

Abstract The purpose of this research is to make a 3D animated video that is used to provide information about the ethics of driving at intersections and roundabouts in accordance with the rules that apply to the public or vehicle users, in order to reduce the level of traffic accidents. The making of this 3-dimensional animated video starts with the initial stage, namely determining the idea, the data collection stage, to designing the storyboard. After that, the modeling, texturing, rigging animating, and rendering stage are carried out, using the Blender and Makehuman applications which then produce several 3-dimensional animated video pieces. After the rendering process is complete, the next stage is final editing by providing text, images, transition effects using the Adobe Premiere Pro application and adding audio as voice over to the story script. The last stage is the final rendering which produces a 3-dimensional animated video in the MP4 file format. Abstrak Tujuan dari penelitian ini adalah pembuatan video animasi 3D yang digunakan untuk memberikan informasi tentang etika berkendara di simpangan dan bundaran sesuai dengan aturan yang berlaku bagi masyarakat atau pengguna kendaraan, agar dapat mengurangi tingkat kecelakaan lalu lintas. Pembuatan video animasi 3 dimensi ini, dimulai dengan tahap awal yaitu penentuan ide, tahap pengumpulan data, hingga perancangan storyboard. setelah itu dilakukan proses modelling, texturing, rigging animating, hingga tahap rendering, dengan menggunakan aplikasi Blender dan Makehuman yang kemudian menghasilkan beberapa potongan-potongan video animasi 3 dimensi. Setelah proses rendering selesai, tahap selanjutnya adalah final editing dengan memberikan teks, gambar, efek transisi menggunakaan aplikasi Adobe Premiere Pro serta menambahkan audio sebagai pengisi suara pada naskah cerita. Tahap terakhir adalah final rendering yang menghasilkan video animasi 3 dimensi dengan format file MP4.

Purpose The purpose of this study is to investigate the effects of telepresence while using a smartphone-based virtual reality system (SBVR) to explore a hotel virtually and to determine the influence of this immersive experience on the booking intention of the potential customer. Design/methodology/approach Within the scope of this study, a conceptual research model was developed which covered utilitarian and hedonic aspects of the user experience of SBVRs and showed their relevance for the booking intention. A virtual reality application was programmed especially for the study, in which the test persons were able to virtually explore a hotel complex. A total of 569 people participated in the study. A questionnaire was used for the data collection. The structural equation modelling and hypothesis verification were carried out using the partial least squares method. Findings The immersive feeling of telepresence increases the perceived enjoyment and usefulness of the potential customer. In addition, the user's curiosity is aroused by the telepresence, which also significantly increases the perceived enjoyment as well as the perceived usefulness. The hedonic and utilitarian value of the virtual hotel experience increases the probability that the customer will book the travel accommodation. Research limitations/implications The virtual reality application developed for the study is based on static panoramic images and does not contain audio-visual elements (e.g. sound, video, animation). Audio-visual elements might increase the degree of immersion and could therefore be investigated in future research. Practical implications The results of the study show that the SBVR is a suitable marketing tool to present hotels in an informative and entertaining way, and can thereby increase sales and profits. Originality/value For the first time, this study investigates the potential of SBVRs for the virtual product presentation of hotels and provides empirical evidence that the availability of this innovative form of presentation leads to a higher booking intention.

SUMMARY Boat-towed radio-magnetotelluric (RMT) measurements using signals between 14 and 250 kHz have attracted increasing attention in the near-surface applications for shallow water and archipelago areas. A few large-scale underground infrastructure projects, such as the Stockholm bypass in Sweden, are planned to pass underneath such water zones. However, in cases with high water salinity, RMT signals have a penetration depth of a few metres and do not reach the geological structures of interest in the underlying sediments and bedrock. To overcome this problem, controlled source signals at lower frequencies of 1.25 to 12.5 kHz can be utilized to improve the penetration depth and to enhance the resolution for modelling deeper underwater structures. Joint utilization of boat-towed RMT and controlled source audio-magnetotellurics (CSAMT) was tested for the first time at the Äspö Hard Rock Laboratory (HRL) site in south-eastern Sweden to demonstrate acquisition efficiency and improved resolution to model fracture zones along a 600-m long profile. Pronounced galvanic distortion effects observed in 1-D inversion models of the CSAMT data as well as the predominantly 2-D geological structures at this site motivated usage of 2-D inversion. Two standard academic inversion codes, EMILIA and MARE2DEM, were used to invert the RMT and CSAMT data. EMILIA, an object-oriented Gauss–Newton inversion code with modules for 2-D finite difference and 1-D semi-analytical solutions, was used to invert the RMT and CSAMT data separately and jointly under the plane-wave approximation for 2-D models. MARE2DEM, a Gauss–Newton inversion code for controlled source electromagnetic 2.5-D finite element solution, was modified to allow for inversions of RMT and CSAMT data accounting for source effects. Results of EMILIA and MARE2DEM reveal the previously known fracture zones in the models. The 2-D joint inversions of RMT and CSAMT data carried out with EMILIA and MARE2DEM show clear improvement compared with 2-D single inversions, especially in imaging uncertain fracture zones analysed in a previous study. Our results show that boat-towed RMT and CSAMT data acquisition systems can be utilized for detailed 2-D or 3-D surveys to characterize near-surface structures underneath shallow water areas. Potential future applications may include geo-engineering, geohazard investigations and mineral exploration.

New NLP breakthroughs have put Computational Linguistics at a crossroads. NLP's past, present, and future are covered. This review explains computational linguistics' creation with a brief history of linguistics and computer science. Early solutions processed and understood natural language using rule-based systems using manually constructed linguistic rules. Over time, these tactics became increasingly problematic as language became more complex and obscure. Statistical approaches transformed operations. Neural network-based machine learning methods are leading the area because they can learn complicated patterns and representations from large text collections. A data-driven model revolution in natural language processing enhanced language modelling, machine translation, and sentiment analysis. Next, NLP improvements for several tasks and applications are evaluated. Language understanding models that capture semantic nuances and contextual relationships use deep learning frameworks. Word embeddings and transformer-based architectures like GPT and BERT perform well on benchmark datasets for text classification, question answering, and named item identification. The paper also shows how NLP interacts with computer vision, voice processing, and other domains to show the merits and cons of cross-disciplinary research. Multimodal techniques that combine text, graphics, and audio may increase natural language processing and interpretation. The review discusses NLP's effects on prejudice, justice, and privacy. Responsible development and implementation are needed when NLP technology becomes widespread due to algorithmic bias and data privacy concerns. NLP research directions and concerns are reviewed. Existing models may meet standards but fail in practice.

Certains produits du domaine de la technologie musicale présentent des caractéristiques sonores uniques et recherchées par les musiciens. Ces caractéristiques sont souvent dues aux non-linéarités de leurs circuits électroniques. Nous cherchons à préserver le son de ces appareils par le biais de simulations numériques et à les rendre largement accessibles à de nombreux musiciens. Ce domaine d’étude a connu une forte augmentation de l’utilisation des réseaux de neurones pour la simulation au cours des dernières années. Dans ce travail, nous proposons d’utiliser les réseaux neuronaux pour cette tâche. En particulier, nous nous concentrons sur les méthodes de boîte noire capables de fonctionner en temps réel pour la modélisation des effets non linéaires, tout en gardant les contraintes du guitariste à l’esprit. Nous couvrons l’état actuel des connaissances et identifions les domaines qui méritent d’être améliorés ou étudiés, avec pour objectif final le développement d’un produit. La première étape, qui consiste à identifier les architectures capables de traiter en temps réel et en continu, est suivie par l’augmentation et l’amélioration de ces architectures et de leur pipeline d’apprentissage grâce à un certain nombre de méthodes. Ces méthodes comprennent l’intégration continue avec des tests unitaires, l’optimisation automatique des hyperparamètres et l’utilisation de l’apprentissage par transfert. Un prototype en temps réel utilisant un backend C++ personnalisé est créé à l’aide de ces méthodes. Une étude sur l’anticrénelage en temps réel pour les modèles boîte noire est présentée, car il a été constaté que ces réseaux présentent de grandes quantités de distorsion d’anticrénelage. Le travail sur l’incorporation du contrôle de l’utilisateur a également commencé pour une simulation complète des systèmes analogiques. Cela permet à l’utilisateur final de disposer d’une gamme complète de possibilités de modification de la tonalité. Les performances des approches présentées sont évaluées de manière objective et subjective. Enfin, un certain nombre d’orientations possibles pour les travaux futurs sont également présentées
Certain products in the realm of music technology have uniquely desirable sonic characteristics that are often sought after by musicians. These characteristics are often due to the nonlinearities of their electronic circuits. We are concerned with preserving the sound of this gear through digital simulations and making them widely available to numerous musicians. This field of study has seen a large rise in the use of neural networks for the simulation in recent years. This work applies neural networks for the task. Particularly, we focus on real-time capable black-box methods for nonlinear effects modelling, with the guitarist in mind. We cover the current state-of-the-art and identify areas warranting improvement or study with a final goal of product development. A first step of identifying architectures capable of real-time processing in a streaming manner is followed by augmenting and improving these architectures and their training pipeline through a number of methods. These methods include continuous integration with unit testing, automatic hyperparameter optimisation, and the use of transfer learning. A real-time prototype utilising a custom C++ backend is created using these methods. A study in real-time anti-aliasing for black-box models is presented as it was found that these networks exhibit high amounts of aliasing distortion. Work on user control incorporation is also started for a comprehensive simulation of the analogue systems. This enables a full range of tone-shaping possibilities for the end user. The performance of the approaches presented is assessed both through objective and subjective evaluation. Finally, a number of possible directions for future work are also presented

Les humains reçoivent grande quantité d'informations de l'environnement avec vue et l'ouïe . Pour nous aider à réagir rapidement et correctement, il existe des mécanismes dans le cerveau à l'attention de polarisation vers des régions particulières , à savoir les régions saillants . Ce biais attentionnel n'est pas seulement influencée par la vision , mais aussi influencée par l'interaction audio - visuelle . Selon la littérature existante , l'attention visuelle peut être étudié à mouvements oculaires , mais l'effet sonore sur le mouvement des yeux dans les vidéos est peu connue . L'objectif de cette thèse est d'étudier l'influence du son dans les vidéos sur le mouvement des yeux et de proposer un modèle de saillance audio - visuel pour prédire les régions saillants dans les vidéos avec plus de précision . A cet effet, nous avons conçu une première expérience audio - visuelle de poursuite oculaire . Nous avons créé une base de données d'extraits vidéo courts choisis dans divers films . Ces extraits ont été consultés par les participants , soit avec leur bande originale (condition AV ) , ou sans bande sonore ( état ​​V) . Nous avons analysé la différence de positions de l'oeil entre les participants des conditions de AV et V . Les résultats montrent qu'il n'existe un effet du bruit sur le mouvement des yeux et l'effet est plus important pour la classe de la parole à l'écran . Ensuite , nous avons conçu une deuxième expérience audiovisuelle avec treize classes de sons. En comparant la différence de positions de l'oeil entre les participants des conditions de AV et V , nous concluons que l'effet du son est différente selon le type de son , et les classes avec la voix humaine ( c'est à dire les classes parole , chanteur , bruit humain et chanteurs ) ont le plus grand effet . Plus précisément , la source sonore a attiré considérablement la position des yeux uniquement lorsque le son a été la voix humaine . En outre , les participants atteints de la maladie de AV avaient une durée moyenne plus courte de fixation que de l'état de V . Enfin , nous avons proposé un modèle de saillance audio- visuel préliminaire sur la base des résultats des expériences ci-dessus . Dans ce modèle , deux stratégies de fusion de l'information audio et visuelle ont été décrits: l'un pour la classe de son discours , et l'autre pour la musique classe de son instrument . Les stratégies de fusion audio - visuelle définies dans le modèle améliore la prévisibilité à la condition AV
Humans receive large quantity of information from the environment with sight and hearing. To help us to react rapidly and properly, there exist mechanisms in the brain to bias attention towards particular regions, namely the salient regions. This attentional bias is not only influenced by vision, but also influenced by audio-visual interaction. According to existing literature, the visual attention can be studied towards eye movements, however the sound effect on eye movement in videos is little known. The aim of this thesis is to investigate the influence of sound in videos on eye movement and to propose an audio-visual saliency model to predict salient regions in videos more accurately. For this purpose, we designed a first audio-visual experiment of eye tracking. We created a database of short video excerpts selected from various films. These excerpts were viewed by participants either with their original soundtrack (AV condition), or without soundtrack (V condition). We analyzed the difference of eye positions between participants with AV and V conditions. The results show that there does exist an effect of sound on eye movement and the effect is greater for the on-screen speech class. Then, we designed a second audio-visual experiment with thirteen classes of sound. Through comparing the difference of eye positions between participants with AV and V conditions, we conclude that the effect of sound is different depending on the type of sound, and the classes with human voice (i.e. speech, singer, human noise and singers classes) have the greatest effect. More precisely, sound source significantly attracted eye position only when the sound was human voice. Moreover, participants with AV condition had a shorter average duration of fixation than with V condition. Finally, we proposed a preliminary audio-visual saliency model based on the findings of the above experiments. In this model, two fusion strategies of audio and visual information were described: one for speech sound class, and one for musical instrument sound class. The audio-visual fusion strategies defined in the model improves its predictability with AV condition

This study explored the possible impact to a game’s responsiveness and to players’ preferences by using a physically inspired model (real-time pitch and amplitude modulation) as a means of efficiently achieving responsive variation for melee weapon sound effects in a game using the in-engine audio features. A play test was created were 24 participants (12 with audio engineering backgrounds, 12 without), all with prior gaming experience, played through a game level where they would audition a non-variational implementation of a sword’s sound effects and a variational implementation with the same sound samples being modulated in real-time. The participants did not know what they were auditioning, and in a form filled out after the play test they assessed the differences in the level parts’ responsiveness and their preference. From this form no significant benefit or drawback was found to the game’s responsiveness, and no significance was found to the participants’ preference toward either sound effect implementation. The study’s conclusions are that these physically inspired models could be used as a mean of implementation for melee weapon sound effects if the sounds used or the game setting would suit this approach, or if this would be the artistic wish of the game developers.

We are now entering the home stretch, including validation, documentation, implementation and monitoring. (1) Validation—i) high-level—backtesting, stress testing, sensitivity assessments &c; ii) independent oversight—audit and regulatory requirements; iii) quantitative assessments—of ranking ability, accuracy, stability and detailed model functioning. (2) Documentation—i) possible outline; ii) supplementary tables and graphs; iii) selection strategies—cut-offs, and impact assessments; iv) new versus old comparisons—transition matrices and swap sets. (3) Implementation—i) platform choice factors {criticality, budget}; ii) testing—test and implementation platforms, test cases and user testing; iii) further considerations—effects on key segments, what-if analyses, policy rules, option evaluation and use of models in tandem. (4) Monitoring—i) front-end—focused on observation data; ii) back-end—considers performance data at various levels {score, characteristic, attribute}. Selection processes have extra requirements due to the accept/reject and cashed/uncashed statuses plus the extra element of overrides.

A Bridge inspection is routinely conducted to enhance its useful life and ensure user safety within prescribed standards. In this paper, an automated inspection of steel bridges beyond the visual line of sight (BVLOS) is explored with the use of a climbing robot providing live video streams in an augmented reality (AR) environment. We anticipate a reduction in computational complexity involved in stabilizing video feeds due to camera jitter and rolling shutter effects, improved image resolution of observed defects hence their early detection, and reduced training effort to operators through our intuitive interface. Previously, AR has been employed in bridge inspection to visualize building information modelling (BIM), evaluate impact echo delamination, observe bridge deterioration information, update BIM data with higher precision, reduce ambiguity in data collection, support in-office preparations, and extract 3D measurements, using ground robots in collaborative systems. To the best of our knowledge no previous attempt has been made to investigate a collaborative bridge inspection system aided by AR for teleoperation of climbing robots on steel bridges in BVLOS scenarios. The outcome of this research is anticipated to guide future bridge inspection standards towards more computationally efficient systems, minimizing the cognitive workload of the robot pilots compared to unmanned aerial vehicles (UAV) pilots, improving cost effectiveness, with minimal disruption to traffic. Use of real-time audio-visual augmentations will be initially evaluated for a two-person human-robot collaborative system. Visual feedback will be employed to teleoperate the robot on a lab-based steel bridge model while audio feedback is employed to coordinate the two operators across a wireless communication network.

Sonification is an increasingly popular mechanism for data exploration, promoting the need for a greater understanding of human auditory perception and of how sonified information is designed, presented, and interpreted. In this paper, perceptual modelling is used to explore and demonstrate how perceptual phenomena are accounted for in sonification design. The framework, extracted from a larger body of work, links perceptual phenomena such as stream segregation to sonification mappings to provide a systematic approach to identifying and addressing perceptually-driven problems in applied sonification. A web guide functions to situate and guide designers through the complex theoretical constituents of auditory perception incorporated in the Perceptually Congruent Sonification (PerCS) framework. This web guide (hosted on sonification.ie) highlights and summarises the perceptual phenomena most relevant to sonification design and uses simple audio-visual interactions to demonstrate their effect. Preliminary qualitative feedback from a brief survey elucidates a small number of end-user concerns and comments.

Background: Healthcare decision makers strive to operate on the best available evidence. The Agency for Healthcare Research and Quality Evidence-based Practice Center (EPC) Program aims to support healthcare decision makers by producing evidence reviews that rate the strength of evidence. However, the evidence base is often sparse or heterogeneous, or otherwise results in a high degree of uncertainty and insufficient evidence ratings. Objective: To identify and suggest strategies to make insufficient ratings in systematic reviews more actionable. Methods: A workgroup comprising EPC Program members convened throughout 2020. We conducted interative discussions considering information from three data sources: a literature review for relevant publications and frameworks, a review of a convenience sample of past systematic reviews conducted by the EPCs, and an audit of methods used in past EPC technical briefs. Results: Several themes emerged across the literature review, review of systematic reviews, and review of technical brief methods. In the purposive sample of 43 systematic reviews, the use of the term “insufficient” covered both instances of no evidence and instances of evidence being present but insufficient to estimate an effect. The results of the literature review and review of the EPC Program systematic reviews illustrated the importance of clearly stating the reasons for insufficient evidence. Results of both the literature review and review of systematic reviews highlighted the factors decision makers consider when making decisions when evidence of benefits or harms is insufficient, such as costs, values, preferences, and equity. We identified five strategies for supplementing systematic review findings when evidence on benefit or harms is expected to be or found to be insufficient, including: reconsidering eligible study designs, summarizing indirect evidence, summarizing contextual and implementation evidence, modelling, and incorporating unpublished health system data. Conclusion: Throughout early scoping, protocol development, review conduct, and review presentation, authors should consider five possible strategies to supplement potential insufficient findings of benefit or harms. When there is no evidence available for a specific outcome, reviewers should use a statement such as “no studies” instead of “insufficient.” The main reasons for insufficient evidence rating should be explicitly described.

Background Lung cancer is the number one cause of cancer death worldwide.(1) It is the fifth most commonly diagnosed cancer in Australia (12,741 cases diagnosed in 2018) and the leading cause of cancer death.(2) The number of years of potential life lost to lung cancer in Australia is estimated to be 58,450, similar to that of colorectal and breast cancer combined.(3) While tobacco control strategies are most effective for disease prevention in the general population, early detection via low dose computed tomography (LDCT) screening in high-risk populations is a viable option for detecting asymptomatic disease in current (13%) and former (24%) Australian smokers.(4) The purpose of this Evidence Check review is to identify and analyse existing and emerging evidence for LDCT lung cancer screening in high-risk individuals to guide future program and policy planning. Evidence Check questions This review aimed to address the following questions: 1. What is the evidence for the effectiveness of lung cancer screening for higher-risk individuals? 2. What is the evidence of potential harms from lung cancer screening for higher-risk individuals? 3. What are the main components of recent major lung cancer screening programs or trials? 4. What is the cost-effectiveness of lung cancer screening programs (include studies of cost–utility)? Summary of methods The authors searched the peer-reviewed literature across three databases (MEDLINE, PsycINFO and Embase) for existing systematic reviews and original studies published between 1 January 2009 and 8 August 2019. Fifteen systematic reviews (of which 8 were contemporary) and 64 original publications met the inclusion criteria set across the four questions. Key findings Question 1: What is the evidence for the effectiveness of lung cancer screening for higher-risk individuals? There is sufficient evidence from systematic reviews and meta-analyses of combined (pooled) data from screening trials (of high-risk individuals) to indicate that LDCT examination is clinically effective in reducing lung cancer mortality. In 2011, the landmark National Lung Cancer Screening Trial (NLST, a large-scale randomised controlled trial [RCT] conducted in the US) reported a 20% (95% CI 6.8% – 26.7%; P=0.004) relative reduction in mortality among long-term heavy smokers over three rounds of annual screening. High-risk eligibility criteria was defined as people aged 55–74 years with a smoking history of ≥30 pack-years (years in which a smoker has consumed 20-plus cigarettes each day) and, for former smokers, ≥30 pack-years and have quit within the past 15 years.(5) All-cause mortality was reduced by 6.7% (95% CI, 1.2% – 13.6%; P=0.02). Initial data from the second landmark RCT, the NEderlands-Leuvens Longkanker Screenings ONderzoek (known as the NELSON trial), have found an even greater reduction of 26% (95% CI, 9% – 41%) in lung cancer mortality, with full trial results yet to be published.(6, 7) Pooled analyses, including several smaller-scale European LDCT screening trials insufficiently powered in their own right, collectively demonstrate a statistically significant reduction in lung cancer mortality (RR 0.82, 95% CI 0.73–0.91).(8) Despite the reduction in all-cause mortality found in the NLST, pooled analyses of seven trials found no statistically significant difference in all-cause mortality (RR 0.95, 95% CI 0.90–1.00).(8) However, cancer-specific mortality is currently the most relevant outcome in cancer screening trials. These seven trials demonstrated a significantly greater proportion of early stage cancers in LDCT groups compared with controls (RR 2.08, 95% CI 1.43–3.03). Thus, when considering results across mortality outcomes and early stage cancers diagnosed, LDCT screening is considered to be clinically effective. Question 2: What is the evidence of potential harms from lung cancer screening for higher-risk individuals? The harms of LDCT lung cancer screening include false positive tests and the consequences of unnecessary invasive follow-up procedures for conditions that are eventually diagnosed as benign. While LDCT screening leads to an increased frequency of invasive procedures, it does not result in greater mortality soon after an invasive procedure (in trial settings when compared with the control arm).(8) Overdiagnosis, exposure to radiation, psychological distress and an impact on quality of life are other known harms. Systematic review evidence indicates the benefits of LDCT screening are likely to outweigh the harms. The potential harms are likely to be reduced as refinements are made to LDCT screening protocols through: i) the application of risk predication models (e.g. the PLCOm2012), which enable a more accurate selection of the high-risk population through the use of specific criteria (beyond age and smoking history); ii) the use of nodule management algorithms (e.g. Lung-RADS, PanCan), which assist in the diagnostic evaluation of screen-detected nodules and cancers (e.g. more precise volumetric assessment of nodules); and, iii) more judicious selection of patients for invasive procedures. Recent evidence suggests a positive LDCT result may transiently increase psychological distress but does not have long-term adverse effects on psychological distress or health-related quality of life (HRQoL). With regards to smoking cessation, there is no evidence to suggest screening participation invokes a false sense of assurance in smokers, nor a reduction in motivation to quit. The NELSON and Danish trials found no difference in smoking cessation rates between LDCT screening and control groups. Higher net cessation rates, compared with general population, suggest those who participate in screening trials may already be motivated to quit. Question 3: What are the main components of recent major lung cancer screening programs or trials? There are no systematic reviews that capture the main components of recent major lung cancer screening trials and programs. We extracted evidence from original studies and clinical guidance documents and organised this into key groups to form a concise set of components for potential implementation of a national lung cancer screening program in Australia: 1. Identifying the high-risk population: recruitment, eligibility, selection and referral 2. Educating the public, people at high risk and healthcare providers; this includes creating awareness of lung cancer, the benefits and harms of LDCT screening, and shared decision-making 3. Components necessary for health services to deliver a screening program: a. Planning phase: e.g. human resources to coordinate the program, electronic data systems that integrate medical records information and link to an established national registry b. Implementation phase: e.g. human and technological resources required to conduct LDCT examinations, interpretation of reports and communication of results to participants c. Monitoring and evaluation phase: e.g. monitoring outcomes across patients, radiological reporting, compliance with established standards and a quality assurance program 4. Data reporting and research, e.g. audit and feedback to multidisciplinary teams, reporting outcomes to enhance international research into LDCT screening 5. Incorporation of smoking cessation interventions, e.g. specific programs designed for LDCT screening or referral to existing community or hospital-based services that deliver cessation interventions. Most original studies are single-institution evaluations that contain descriptive data about the processes required to establish and implement a high-risk population-based screening program. Across all studies there is a consistent message as to the challenges and complexities of establishing LDCT screening programs to attract people at high risk who will receive the greatest benefits from participation. With regards to smoking cessation, evidence from one systematic review indicates the optimal strategy for incorporating smoking cessation interventions into a LDCT screening program is unclear. There is widespread agreement that LDCT screening attendance presents a ‘teachable moment’ for cessation advice, especially among those people who receive a positive scan result. Smoking cessation is an area of significant research investment; for instance, eight US-based clinical trials are now underway that aim to address how best to design and deliver cessation programs within large-scale LDCT screening programs.(9) Question 4: What is the cost-effectiveness of lung cancer screening programs (include studies of cost–utility)? Assessing the value or cost-effectiveness of LDCT screening involves a complex interplay of factors including data on effectiveness and costs, and institutional context. A key input is data about the effectiveness of potential and current screening programs with respect to case detection, and the likely outcomes of treating those cases sooner (in the presence of LDCT screening) as opposed to later (in the absence of LDCT screening). Evidence about the cost-effectiveness of LDCT screening programs has been summarised in two systematic reviews. We identified a further 13 studies—five modelling studies, one discrete choice experiment and seven articles—that used a variety of methods to assess cost-effectiveness. Three modelling studies indicated LDCT screening was cost-effective in the settings of the US and Europe. Two studies—one from Australia and one from New Zealand—reported LDCT screening would not be cost-effective using NLST-like protocols. We anticipate that, following the full publication of the NELSON trial, cost-effectiveness studies will likely be updated with new data that reduce uncertainty about factors that influence modelling outcomes, including the findings of indeterminate nodules. Gaps in the evidence There is a large and accessible body of evidence as to the effectiveness (Q1) and harms (Q2) of LDCT screening for lung cancer. Nevertheless, there are significant gaps in the evidence about the program components that are required to implement an effective LDCT screening program (Q3). Questions about LDCT screening acceptability and feasibility were not explicitly included in the scope. However, as the evidence is based primarily on US programs and UK pilot studies, the relevance to the local setting requires careful consideration. The Queensland Lung Cancer Screening Study provides feasibility data about clinical aspects of LDCT screening but little about program design. The International Lung Screening Trial is still in the recruitment phase and findings are not yet available for inclusion in this Evidence Check. The Australian Population Based Screening Framework was developed to “inform decision-makers on the key issues to be considered when assessing potential screening programs in Australia”.(10) As the Framework is specific to population-based, rather than high-risk, screening programs, there is a lack of clarity about transferability of criteria. However, the Framework criteria do stipulate that a screening program must be acceptable to “important subgroups such as target participants who are from culturally and linguistically diverse backgrounds, Aboriginal and Torres Strait Islander people, people from disadvantaged groups and people with a disability”.(10) An extensive search of the literature highlighted that there is very little information about the acceptability of LDCT screening to these population groups in Australia. Yet they are part of the high-risk population.(10) There are also considerable gaps in the evidence about the cost-effectiveness of LDCT screening in different settings, including Australia. The evidence base in this area is rapidly evolving and is likely to include new data from the NELSON trial and incorporate data about the costs of targeted- and immuno-therapies as these treatments become more widely available in Australia.