Level Of Consensus Research Articles (Page 1)

Nuclear data bears a critical nexus with marine radioactive pollution surveillance, serving as the evidentiary foundation for source attribution and impact assessment. This article adopts an empirical research approach, integrating nuclide simulation modeling with radioactive monitoring data, to demonstrate that Japan's discharge of Fukushima radioactive wastewater has resulted in the dispersion of radionuclides from inland waters into the North and West Pacific Transition Zones via ocean currents, thereby posing potentially irreversible, multigenerational threats to marine ecosystems. The current deficiencies in the international legal governance framework for marine pollution-combined with weak legal enforcement, a low level of cooperative consensus, and a transparency deficit in radioactive pollution monitoring-further exacerbate these risks. Accordingly, employing a doctrinal research method, this article examines the legal foundations for a Pacific Rim regional nuclear data regulatory framework and proposes a regional legal cooperation mechanism composed of legal principles, legal rules, organizational structures, and operational procedures. By constructing such a mechanism, the transparency of radioactive waste disposal monitoring data can be enhanced, the legal accountability challenges arising from Japan's wastewater discharge mitigated, and regional consensus strengthened on nuclear data classification, monitoring, and disclosure-ultimately improving the safety of nuclear energy development and utilization within the Pacific Rim.

BackgroundDespite a lack of evidence relating to effectiveness and safety, the use of apps in the field of mental health is increasing due to their ease of use and accessibility. The aim of the EvalDepApps project is to develop and validate an assessment tool for evaluating depression management apps based on scientific evidence, expert judgement and end-user needs.ObjectiveThe purpose of this study was to determine the most relevant criteria for evaluating apps intended to manage depression through consensus-based assessment.MethodsA total of 43 individuals were invited to participate in an online modified Delphi study of 51 criteria identified from the literature. In Round 1, participants rated criteria according to relevance and three levels of consensus were defined: high level when ≥80% of respondents scored the criterion at 5 or 6; medium when 60%–79% of respondents scored the criterion at 5 or 6 and low when <60% of respondents scored the criterion at 5 or 6. In Round 2, participants were asked to re-rate criteria that had achieved the medium level of consensus in Round 1 under the same parameters. Comments by participants were collected and analysed. The final assessment list consisted of those criteria that had attained the maximum consensus in either round.FindingsThe response rate was 59.0% (26/43) in Round 1 and 53.4% (23/43) in Round 2. In Round 1, 24 criteria (47.1%) attained the maximum level of consensus, 20 (39.2%) the medium level and 7 (13.7%) the lowest level. In Round 2, 4 out of 20 criteria (20.0%) attained the maximum consensus. Participant comments reinforced the relevance of the selected criteria. The final list consisted of 28 criteria, the majority relating to Safety and Privacy and Clinical Effectiveness (25.0% each), followed by Usability and Functionality (17.9%).ConclusionsBy prioritising criteria relating to data safety and clinical effectiveness, participants in this study emphasised that the assessment of apps for depression management must take both these aspects into full consideration. Despite some limitations of the study (eg, lack of participant sociodemographic data and its implications for generalisation, not face-to-face inter-round), the results of this study will enable the EvalDepApps project to develop an assessment tool for depression management apps that incorporates the most relevant criteria.Clinical implicationsEvalDepApps will support healthcare professionals and users in identifying safe, effective and user-friendly depression management apps.

The goal was to develop a pragmatic classification system for conditions associated with chronic pelvic pain (CPP), aiming to enhance diagnosis, management, education, and research of CPP. An international, multidisciplinary panel participated in a modified RAND/UCLA Delphi consensus. This panel included healthcare professionals, medical society representatives, experts, individuals with lived experience of pain, advocacy groups, researchers, educators, and journal editors. The Delphi process comprised three rounds: two online surveys and one virtual meeting. Participants scored their agreement with statements using a 9-point Likert scale (1 = strongly disagree, 9 = strongly agree). A priori criteria for consensus were defined as follows: agreement, a mean score ≥7 with <15% scoring ≤3; disagreement, a mean score ≤3 with <15% scoring ≥7. Responses not meeting these criteria were considered indeterminate and advanced for further refinement in subsequent rounds. In round 1, 65 of 77 (84.4%) stakeholders participated; round 2 consisted of responses from 54 (70.1%) stakeholders, and 34 (44.2%) stakeholders engaged in round 3. The Delphi process yielded broad consensus on the definition of CPP and a corresponding classification system with the acronym R U MOVVING SOMe. This novel system comprises 12 categories: Reproductive, Urinary, Musculoskeletal, Other (not otherwise classified), Vulvovaginal, Vascular, Idiopathic (no pain contributor identified), Neurologic, Gastrointestinal, Sensitization/Nociplastic, Overlapping pain conditions, and Mental health. The R U MOVVING SOMe classification system represents a significant step towards a standardized framework for evaluating CPP. The high level of engagement and consensus among a diverse group of international stakeholders underscores its future potential to improve communication, clinical practice, education, and research in this challenging field.

This study focuses on designing a project-based learning module for early science education for home-based learning. The module comprises four dimensions: plants, planets, magnets and robotics, and weather. Using a quantitative approach and the design and development research (DDR) method, 15 early childhood education (ECE) experts were surveyed through a questionnaire with 20 items on a seven-point Likert scale. The Fuzzy Delphi method (FDM) with triangular Fuzzy numbers (TFN) was employed for data analysis, revealing a high level of expert consensus on the essential components of the module. The study achieved over 75% agreement, exceeding the threshold value (d) of 0.2 and α-cut of 0.5. Each dimension received favorable acceptance scores: plants (0.874), magnets and robotics (0.890), planets (0.918), and weather (0.903). The study emphasizes the acceptability of expert opinions on these dimensions, providing a valuable resource for early science education at home. The findings support addressing gaps in contributing to achieving sustainable development goal 4.2 by ensuring access to quality education for children.

Purpose This Delphi study aimed to assess the skills, knowledge and competencies needed by agricultural leadership graduates at Oklahoma State University, as perceived by undergraduate program alumni. Design/methodology/approach The Delphi method was employed, engaging a panel of 20 undergraduate program alumni with at least two years of agricultural industry experience ranging from education, agribusiness, public relations and government. Findings We found alumni highly valued transferable skills (e.g. communication, critical thinking, teamwork, adaptability and emotional intelligence). Technical and agricultural industry-specific skills were acknowledged, but did not reach as high a level of consensus. Research limitations/implications This finding suggests programs should consider the individual needs of students, rather than a “one size fits all” approach to curriculum. These findings provide valuable insights for curriculum development practitioners and program evaluators to ensure agricultural leadership undergraduate program students are adequately prepared to meet the demands of a diverse 21st century workforce. Practical implications The results support current literature’s assertion universities should incorporate alumni experiences when developing and evaluating agricultural leadership programming. Originality/value Further, these results underscore the value of leadership education in preparing students for careers in the agricultural industry.

BackgroundAn effective and efficient response to health needs requires the development of an evidence-based health service. Public health nurses are considered to be key practitioners of health service development in Japanese health administration, increasing the importance of the role of health service development. The purpose of this study is to build a practice model for evidence-based health service development adapted to the context of public health nursing in Japan (“Practice Model”).MethodsThe draft Practice Model consisted of 17 items grouped into three stages, was developed through literature research and regular consultations by the study team and feedback at two public gatherings. The framework and item-pool of the initial draft were built on implementation science models meeting one or more of the criteria set by the study team. The survey was conducted using the Delphi method, a consensus formation technique, and consisted of three rounds of self-administered questionnaires. The expert panel was formed by sending a request letter to supervising PHNs and PHN training course professors nationwide, and selecting those who expressed their willingness to cooperate and met the selection criteria.Results99 expert panel joined in Round 1 (52 practitioners and 47 faculty), of whom 81 cooperated in all three surveys. As a result of three rounds of opinion gathering and revision, high percentages of agreement of 80% or over were obtained in all rounds for all items. In particular, in Round 3, the percentages of agreement of 95% or over were achieved for all items.ConclusionsThe results of the Delphi survey showed that the Practice Model, which underwent revisions after each round, achieved a high level of consensus and was modified. The Practice Model clearly outlined the structure of evidence-based health service development. The novelty of this model lies in its structure, which includes three stages—the preparation stage (Type 1 evidence focus), the implementation stage (Type 2 evidence focus), and the dissemination stage (Type 3 evidence focus)—and incorporates important processes such as the Plan‑Do‑Check‑Act cycle and implementation science, while also positioning continuing professional development as the foundation for practice. In the future, the utilization of this Practice Model will serve as on-the-job training to enhance the health service development capabilities of public health nurses, which in turn is expected to improve the quality of evidence-based public health in the field.Clinical trial numberNot applicable.Supplementary informationThe online version contains supplementary material available at 10.1186/s12912-025-03820-4.

Objectives: To identify the competencies regarding entrustable professional activities among postgraduate plastic surgery residents for informed consent taking before any elective surgical procedure and to choose the appropriate assessment strategies. Method: The Modified Delphi study was conducted from July 2022 to January 2023 after approval from the ethics review committee of the Islamic International Medical College, Islamabad, Pakistan, and comprised two iterative rounds using the expert consensus approach involving consultant plastic surgeons serving in public, private and military teaching hospitals in Pakistan and abroad. Following literature search, competencies related to informed consent before elective plastic surgery procedures were identified. A 5-point Likert scale was formulated and the document was distributed online. Items reaching consensus level were included in the final document. The competencies that failed to reach the consensus level or needed amendments were sent in the second round along with additional questions regarding assessment strategies and supervision level. Data was analysed using SPSS 21. Results: Of the 51 plastic surgery consultants, 30(58.8%) responded in the first round. Out of 58 competencies initially identified, 49(84.5%) reached consensus level. No new entrustable professional activities or competencies were identified. Of the 9 competencies in the second round, consensus was achieved on 6(67.7%), with the response rate being 70%. The final set comprised 55 competencies under 8 entrustable professional activities. Conclusion: The entrustable professional activities identified provide a comprehensive competence-based assessment framework for taking informed consent in plastic surgery practice. Key Words: Plastic surgery residency, Entrustable professional activities, EPAs, Informed consent taking.

A Delphi study on valuing DNA sequencing in oncology: a European stakeholder developed framework for assessing next generation sequencing and comprehensive genomic profiling diagnostics

Despite decades of endovascular treatment (EVT) of intracranial aneurysms (IA), there are no studies regarding the ideal working projections. Possible correlations between suboptimal working projections and procedure-related complications therefore remain unknown. This study aims at investigating the level of consensus between different physicians proposed working projections for endosaccular treatment of IAs. Five interventional neuroradiologists used asimulation software to select what they considered to be the optimal biplane working projections (BPW) for the intrasaccular treatment of 20 intracranial aneurysms. Five further raters evaluated these projections and either agreed or disagreed with the proposed working projection. Where necessary, reasons for rejecting the proposed working projection was provided. Overall, a substantial interobserver consensus was achieved (κ = 0.81), with at least one projection consistently agreed upon for 19 out of 20 aneurysms. Conversely, only one projection was unanimously rejected. Lack of clear delineation of the aneurysm neck, the parent vessel, and associated vessels were the most frequently cited reasons for rejection (39%, 39%, and 31%, respectively), while "other reasons" accounted for 19%. Although the specific working projections chosen for individual aneurysms were heterogeneous, there was still a broad consensus on at least one suitable projection for almost every case. Further research is required to explore the possible benefit of adjusting the patient's head position or making slight angle deviations in BWPs with physical restrictions and furthermore, to evaluate the risks associated with suboptimal BWPs in EVT.

Purpose Nowadays, receiving construction materials and goods on time and at the exact location is a big challenge for construction organizations. Last-mile delivery focuses on the last step of delivery of the general goods to the end customer in a streamlined way. Whereas oversized items are the exception for general commodities, construction materials are often heavy and include a wide range of irregularly shaped items. Also, construction sites have limited storage space and strict safety regulations. These challenges make the last-mile delivery of the construction industry different from general goods delivery. This study proposes a novel framework for evaluating construction suppliers in last-mile delivery of the construction supply chain management. Design/methodology/approach First, the most relevant last-mile delivery criteria associated with the construction sites are identified. Then, a zero-one nonlinear programming model is proposed with the aid of Kendall's coefficient of concordance to formulate the optimistic and pessimistic scenarios for expert opinions and determine the required number of experts. Later, using the ordinal priority approach (OPA) to identify the qualified construction supplier for last-mile delivery. Findings Based on the results of the study, the number of required experts for the supplier selection problem is a decision variable and should be optimized using mathematical programming for every specific problem. Several factors, such as conflict among experts and the stability of final ranks, can affect the required number of experts directly. Research limitations/implications The current study's practical implication is helping executives evaluate suppliers based on their contributions to delivering the materials and services to the end customer. Originality/value In this study, a novel framework is proposed with the aid of the OPA and zero-one nonlinear programming to select the construction suppliers. The optimal number of experts ensures a particular consensus level in the evaluation process, decreasing future risks and problems. The proposed method addresses scholars’ concerns about engaging enough experts for gathering reliable input data in decision-making problems.

Background Trauma-informed care (TIC) is a framework to recognize and respond to all types of trauma, prevent re-traumatization, and promote resilience. Trauma includes any event that is physically or emotionally harmful and has lasting adverse effects. While TIC strategies are increasingly emphasized in medical education, thus far no core competencies exist to guide competency-based education in postgraduate education. Objective To build consensus on core competencies in TIC for emergency medicine (EM). Methods We recruited experts in TIC via snowball sampling to participate in a modified Delphi process. Panelists ranked competencies on a 5-point Likert scale through electronic survey. Threshold for consensus was defined as a mean of 3.75. Thematic analysis was performed on survey free-text responses and transcripts of virtual discussions using inductive and invivo codes. Results Sixteen panelists across 12 institutions participated in the modified Delphi, and 49 initial competencies were proposed. During round 1, 100% of the competencies exceeded the consensus level, but many panelists offered suggestions and changes. Thus, we conducted 2 virtual discussions and reorganized the proposed competencies into 19 competencies in round 2. We further narrowed to 16 competencies in round 3. Thematic analyses were used between rounds to organize panelists' comments for revisions. There were no major changes proposed by panelists after round 3, and all competencies exceeded the consensus level. Examples of the final competencies include "define trauma," and "describe the widespread impact of trauma on health." Conclusions We achieved consensus on 16 core competencies for EM physicians in training.

45 Background: EPI is a prevalent, overlooked condition in PC impacting nutritional status, treatment tolerance &amp; QOL. Evidence on pancreatic exocrine replacement therapy (PERT) in PC shows improvements in malabsorption, weight, QOL, sarcopenia, and survival increases. In the U.S, a lack of comprehensive guidelines on EPI/PERT in PC leaves a critical gap. Canopy engaged researchers to identify U.S. priorities in clinical practice to inform guideline development through expert consensus. Methods: A national Working Group (n = 12) convened. A mixed-methods approach and modified Delphi were used: Lit review; 6x focus groups (n=28; Patients/HCPs); 6 virtual meetings to develop consensus statements (CCS); 2 Delphi survey rounds deployed. Quant. ratings were analyzed for median &amp; IQRs). Consensus was defined as ≥ 70% in agreement/strong agreement. CCS were validated for clinical feasibility &amp; impact. Results: The15 CCS address critical domains in care &amp; represent the first comprehensive recommendations standardizing EPI and PERT management in PC in the US. Conclusions: These statements offer practical guidance to improve EPI diagnosis &amp; management in PC. Standardizing practice can reduce variability and improve outcomes. Wider adoption and iterative refinement of these recommendations through implementation is needed to validate clinical outcomes and further optimize care. Highlights from the 1st U.S. clinical consensus statements on EPI in panc cancer. Domain Statement Consensus Level Standards &amp; Ethics EPI/PERT standards should be integrated into PC guidelines &amp; MDC planning. 88% Screening &amp; Clinical Criteria All PC patients should be screened for EPI &amp; re-screened at intervals after. Given prevalence in PC, EPI in PC can be diagnosed through assessing symptoms/nutritional status, without PFTs (FE-1).EPI can be suspected when a patient presents with unintentional weight loss despite adequate intake, plus min. 1 additional EPI s/s, OR presentation w/ 2-3 EPI s/s without unintentional weight loss, despite adequate intake. 94% 88% 81% Therapeutic Principles Trialing PERT is considered safe &amp; effective in symptomatic PC patients with OR without a clinical EPI Dx. 88% Access Practical considerations for Rx should include cost; pill burden; religious beliefs. 100% Dosing &amp; Management Sugg. starting dose: 48,000 - 72,000 units/meal; 24,000-36,000 units/snack.Routine monitoring for dose adjustments should occur within 2 weeks after initiating PERT and with onset of any new/worsening s/s. 94% 94%

CALM ICU guidelines: Preliminary guidelines on non-pharmacological strategies for agitation in the ICU - A Delphi study.

Background:Predicting outcome for individuals with dystonia undergoing treatment with deep brain stimulation (DBS) remains challenging. This is further complicated by a lack of uniform screening, follow-up, and heterogeneous outcome measures. This study aims to achieve consensus on a national level among experts in the field to develop an agreed set of outcome measures and introduce more uniformity in the process of preoperative screening and follow-up.Methods:A modified Delphi process was conducted among experts in the field of DBS for dystonia. The process consisted of an inventory round, followed by two rounds of Delphi questionnaires, closing with a digital consensus meeting. Experts rated the importance of items within several categories: ((non-)motor symptoms, selection criteria, follow-up, DBS-related aspects, involved care providers). A threshold of 70% was maintained as consensus criterium.Results:After the first two rounds, consensus was reached on 40/59 items (adult DBS), and 47/61 items (pediatric DBS). The remaining items were rephrased into 28 statements (13 adult DBS, 13 pediatric DBS, and 2 concerning both) and voted on during a final consensus meeting. There, 23/28 statements (11 adult, 11 pediatric, 1 both) reached consensus. Overall, after three rounds, on most items consensus was reached.Discussion:In this Delphi study, a high level of consensus among national experts was achieved on outcome measures and the process of screening and follow-up in DBS for dystonia for adults and children. The results present national consensus and offer an excellent start for collaborative international studies on best practice for DBS in dystonia.

ObjectiveIn emergency medical services (EMS), work environments and circumstances are variable and make clinical judgement challenging. Little is known about the human factors that can affect paramedics’ clinical judgement in different situations. The aim of this study was to identify the key human factors that can affect paramedics’ clinical judgement during EMS missions, according to paramedic experts.MethodsA three-round modified Delphi study was conducted in 2024. Advanced level paramedics with at least five years of experience in EMS across Finland were included in the study. In the first two rounds, experts evaluated statements using seven- and five-point Likert scales. In Round 3, experts selected the five most significant human factors affecting paramedics’ clinical judgement and describe related situations. The consensus level was set at ≥ 75%, and open-ended responses were analysed using thematic analysis.ResultsForty-seven experts participated in Round 1 and the response rates for Rounds 2 and 3 were 91% and 58%, respectively. After Round 1,16 statements were removed, 20 new statements were introduced, and four original statements were revised for Round 2. As consensus was not reached in the first two rounds, the analysis approach was modified to report medians and interquartile ranges (IQR). The experts identified 13 key human factors (IQR ≤ 1), with the four most significant being: 1) Unsafe locations involving a perceived risk to one’s own and/or colleagues’ work safety; 2) One’s own attitude towards work tasks; 3) Support received from a physician when carrying out the mission, and 4) One’s own and one’s work partner’s problem-solving ability in relation to the situation at the scene.ConclusionsThe present study found consensus on the four most significant human factors affecting paramedics’ clinical judgement. Organisations need to provide adequate resources for situations involving occupational safety risks and provide support for paramedics’ mental wellbeing.

ABSTRACT Although the European Union (EU) has sought to promote the approximation of the foreign policy positions of member states since it established its Common Foreign and Security Policy (CFSP) with the Treaty of Maastricht in 1992, the impact of this intergovernmental forum has long been questioned. Recent developments putting the CFSP under strain such as the weakening transatlantic link, Russian attempts to undermine EU foreign policy unity, and the rise of Eurosceptic populist parties call for a reassessment of its convergence-fostering effect. We investigate convergence by looking at EU voting behavior on resolutions on nuclear weapons—a controversial area due to deep divisions among member states—at the United Nations General Assembly from 1979 to 2022. We show that while convergence among CFSP participants hardly increases, the level of consensus remains stable, in a departure from the theoretical expectations of mainstream accounts of EU foreign policy.

Upper extremity post-thrombotic syndrome score: consensus results from an international Delphi study.

This article focuses on developing scientifically grounded approaches to enhance Ukraine's migration policy framework, fostering a secure environment, and supporting national recovery. The primary aim is to construct scenario-based projections of the EU migration crisis caused by Russia's full-scale invasion of Ukraine.To achieve this, a multi-stage research design was applied, centered on scenario analysis using the Shell matrix approach. The first stage analyzed migration flows triggered by the invasion, examining their scale, trajectory, and implications for both Ukraine and the EU. It also explored migrants’ return intentions and the emotional and socio-economic factors influencing them.The second stage identified key drivers of migration since the onset of the war and used these findings to build a matrix model of influencing factors. The third stage addressed critical uncertainties—unpredictable but pivotal elements shaping Ukraine’s security landscape—forming a basis for scenario planning.In the fourth stage, three core migration scenarios were developed—optimistic, realistic, and pessimistic—mapped along two axes: the war's duration/outcome and the EU's integration stance toward Ukraine. The fifth stage involved expert evaluation of each scenario's feasibility and the level of consensus regarding its plausibility.The final stage led to the formulation of a conceptual legal framework through the proposed "Soft Return" state program. This program introduces legal tools for integrating migration policy into Ukraine's national security agenda, with a focus on facilitating the return of human capital. It includes provisions for legislative support, diaspora engagement mechanisms, and instruments for remote civic and economic participation, such as e-residency and digital platforms.By aligning legal reform with strategic foresight, the study presents a forward-looking model for migration governance under wartime conditions.

To assess clinical trends to prevent peri-implantitis in applying a two-step survey based on the Delphi method. A panel of participants aged < 45 years old selected by the Spanish Society of Periodontology (SEPA) was asked to answer a survey with 75 statements prepared by a steering committee. Items were divided into 5 major areas: etiopathogenesis and epidemiology, surgical, implant, and prosthetic-related factors on the onset/progression of peri-implantitis, and self- and professional-administered oral hygiene. Degree of agreement or disagreement among participants was reported. In total, 44 participants responded favorably to participate in the survey. From the 75 statements formulated, 35 were agreed on in a first round (46.7%). From the 40 statements that did not reach consensus, 16 were agreed on in a second round (40.0%). Overall, 51 out of 75 statements (68.0%) achieved consensus in a second round. From these, 36 (48.0%) were in agreement, while 15 (20.0%) were in disagreement. The sections that explored surgical-related factors and prosthesis-related factors of peri-implantitis yielded the highest level of conflict (9/18 and 8/14 statements demonstrated indeterminate agreement, respectively). In the sections on the etiopathogenesis and epidemiology of peri-implantitis and implant-related factors, most items reached consensus (14/17 and 10/13 items, respectively). The section on self- and professional-administered oral hygiene obtained the highest level of consensus, with only 1/13 items showing dissent among the participants. The results of this study on the clinical trends in the prevention of peri-implantitis showed consensus agreement for ∼70% of the statements evaluated.

We aimed to explore SARS-CoV-2 evolution during in vitro neutralisation using next generation sequencing, and to determine whether sera from individuals immunised with two doses of the Pfizer-BioNTech vaccine (BNT162b2) were as effective at neutralising the variant of concern (VOC) Delta (B.1.617.2) compared to the earlier lineages Beta (B.1.351) and wild-type (A.2.2) virus. Using a live-virus SARS-CoV-2 neutralisation assay in Vero E6 cells, we determined neutralising antibody titres (nAbT) against three SARS-CoV-2 strains (wild type, Beta, and Delta) in 14 participants (vaccine-naïve (n = 2) and post-second dose of BNT162b2 vaccination (n = 12)), median age 45 years [IQR 29–65]; the median time after the second dose was 21 days [IQR 19–28]. The determination of nAbT was based on cytopathic effect (CPE) and in-house quantitative reverse transcriptase real-time quantitative polymerase chain reaction (RT-qPCR) to confirm SARS-CoV-2 replication. A total of 110 representative samples including inoculum, neutralisation breakpoints at 72 h, and negative and positive controls underwent genome sequencing. By integrating live-virus neutralisation assays with deep sequencing, we characterised both functional antibody responses and accompanying viral genetic changes. There was a reduction in nAbT observed against the Delta and Beta VOC compared with wild type, 4.4-fold (p ≤ 0.0006) and 2.3-fold (p = 0.0140), respectively. Neutralising antibodies were not detected in one vaccinated immunosuppressed participant and the vaccine-naïve participants (n = 2). The highest nAbT against the SARS-CoV-2 variants investigated was obtained from a participant who was vaccinated following SARS-CoV-2 infection 12 months prior. Limited consensus level mutations occurred in the various SARS-CoV-2 lineage genomes during in vitro neutralisation; however, consistent minority allele frequency variants (MFV) were detected in the SARS-CoV-2 polypeptide, spike (S), and membrane protein. Findings from countries with high COVID-19 incidence may not be applicable to low-incidence settings such as Australia; as seen in our cohort, nAbT may be significantly higher in vaccine recipients previously infected with SARS-CoV-2. Monitoring viral evolution is critical to evaluate the impact of novel SARS-CoV-2 variants on vaccine effectiveness, as mutational profiles in the sub-consensus genome could indicate increases in transmissibility and virulence or suggest the development of antiviral resistance.