Resumption Of Activities Research Articles

Analyzing the Influence of Vehicular Traffic on the Concentration of Pollutants in the City of São Paulo: An Approach Based on Pandemic SARS-CoV-2 Data and Deep Learning

This study employs surface and remote sensing data jointly with deep learning techniques to examine the influence of vehicular traffic in the seasonal patterns of CO, NO2, PM2.5, and PM10 concentrations in the São Paulo municipality, as the period of physical distancing (March 2020 to December 2021), due to SARS-CoV-2 pandemic and the resumption of activities, made it possible to observe significant variations in the flow of vehicles in the city of São Paulo. Firstly, an analysis of the planetary boundary layer height and ventilation coefficient was performed to identify the seasons’ patterns of pollution dispersion. Then, the variations (from 2018 to 2021) of the seasonal average values of air temperature, relative humidity, precipitation, and thermal inversion occurrence/position were compared to identify possible variations in the patterns of such variables that would justify (or deny) the occurrence of more favorable conditions for pollutants dispersion. However, no significant variations were found. Finally, the seasonal average concentrations of the previously mentioned pollutants were compared from 2018 to 2021, and the daily concentrations observed during the pandemic period were compared with a model based on an artificial neural network. Regarding the concentration of pollutants, the primarily sourced from vehicular traffic (CO and NO2) exhibited substantial variations, demonstrating an inverse relationship with the rate of social distancing. In addition, the measured concentrations deviated from the predictive model during periods of significant social isolation. Conversely, pollutants that were not primarily linked to vehicular sources (PM2.5 and PM10) exhibited minimal variation from 2018 to 2021; thus, their measured concentration remained consistent with the prediction model.

Teacher’s Role in Developing Student Discipline Character during The New Normal Era at SDIT Al-Khairiyah Cilegon

Education is not only about academics but also about the development of character values, including in education. Given how essential character education is, efforts to develop character values continue to be carried out, where one of the characteristics that need to be fostered is the character of discipline even in the new normal era. This research was conducted to find out: 1) efforts to develop the discipline character of students, 2) the role of the teacher in implementing the discipline character of students, and 3) the discipline character of grade IV/B students in the new normal era at SDIT Al-Khairiyah Cilegon. The method employed in this research was qualitative, following the data and facts found, and then the data used in this study were obtained through non-participatory observations, which the researchers put into field notes, documents, and interviews with several sources. The results of this study highlighted that 1) teachers were firm in enforcing rules, applying exemplary habits, and setting good examples for students. 2) The grade IV/B homeroom teacher continuously attempted to set an example of discipline, one of which was by arriving on time. Then, the school provided support, such as improving school facilities and infrastructure and working with the surrounding health centers to provide socialization and vaccination to students to prevent the spread of the COVID-19 virus. 3) The disciplinary character of students has developed with the resumption of habituation activities in the new normal era, so the implication going forward is that students become more obedient to the applicable rules in everyday life

One Step Double Augmentation with Human Dermis Allograft and Homologous PRP in Misdiagnosed and or Chronic Achilles Tendon Ruptures.

Misdiagnosed/chronic Achilles tendon injuries are rare and disabling for patients. The surgical treatment of these rare injuries aims to ensure the tendon heals mechanically and biologically. This is the prerequisite for a good clinical and functional outcome and reduces recurrences. The main aim of the study is to present a surgical technique that has proven to be original, reproducible, and capable of guaranteeing solid tendon repair and optimal tissue regeneration. We treated five patients, four males and one female, with the one-step double augmentation technique. All patients of this study complained of pain, but above all severe functional limitation that Achilles tendon injury had been causing for more than a month. In this study, we widely described the surgical technique, original and not found in the literature, which provides a biological graft (allograft of decellularized dermis) and homologous, thrombin-activated, platelet-rich plasma (H-PRP) in a single step. Surgical approach, always used by the first author, respected predefined steps: careful dissection and preparation of the peritendinous tissues from suture to the end of the procedure, tenorrhaphy, and augmentation with allopatch to obtain a mechanically effective repair to avoid recurrences, and finally "biological" augmentation with a unit of homologous, thrombin activated, PRP. We offered to all patients a regenerative rehabilitation program post-operatively. All patients were evaluated clinically (functional clinical tests and questionnaires) and instrumentally (elastic-sonography and perfusion MRI). The obtained results have been evaluated at a minimum follow-up of 18 months and a maximum of 24 months. In all patients pain was resolved, and district function and kinetic chains improved with resumption of daily activities, work, and sports. The present study confirmed the regenerative potential of decellularized dermis allograft and PRP (homologous and thrombin-activated). The same approach can also be exploited in cases of severe tendon destructuring and limited "intrinsic" regenerative potential at any age. The proposed one-step surgical technique of a double augmentation therefore appears useful, safe, reproducible, and applicable in all chronic tendon lesions with low regenerative potential.

Simplified and modified Limberg flap plus vacuum-assisted closure for treatment of sacrococcygeal pilonidal sinus disease.

Pilonidal sinus disease (PSD), a chronic inflammatory disease, affects the sacrococcygeal soft tissue, especially in young adults. The ideal treatment for PSD remains divergence. This study evaluated the application of a simplified modified Limberg flap combined with vacuum-assisted closure for treating PSD. This prospective study was conducted from 1 June 2017 to 31 March 2022 in Changhai Hospital, Naval Military Medical University, Shanghai, China. The study included 88 male patients (91.7%) and 8 female patients (8.3%). The 96 patients ranged in age from 15 to 34 years (mean ± SD, 23 ± 4.4). Under general anaesthesia, all patients underwent simplified modified Limberg flap reconstruction with vacuum-assisted closure. The patient's weight, surgical time, extubation time, hospital stay, time to return to normal life or work, wound infection, wound dehiscence and recurrence rate were recorded. The visual analogue scale (VAS) score and the Vancouver scar score were used to score patients' pain and scars in the surgical area. The volume of resected diseased tissue was 13.5-120 (mean ± SD, 34.993 ± 24.406) cm2 . The average surgical time during the treatment period was 97.68 ± 18.72 min, and the average extubation time was (6.36 ± 1.55) days, the mean hospital stay was 19.4 days; no patients were lost to follow-up. None of the patients experienced post-operative recurrence, wound infection, seroma or hematoma. Six patients (6.3%) experienced wound dehiscence at the flap tip around the natal cleft. The mean time to the resumption of daily activities was 26.3 days. The average VAS pain score was (6.00 ± 1.53) points, and the average Vancouver scar score was (5.96 ± 1.51) points, 12 patients (12.5%) were dissatisfied with their aesthetic results, and the average beauty satisfaction score is (6.64 ± 1.28) points. Simplified modified Limberg flap reconstruction with vacuum-assisted closure surgery is an effective and innovative method for the treatment of PSD, with a low recurrence rate and rapid recovery.

Return to sport after surgery for osteochondral lesions of the talar dome. Results of a multicenter prospective study on 58 patients

IntroductionOsteochondral lesions of the talar dome (OLTD) are most often found in patients for whom the return to sports activities is the main issue. Two types of surgery have been distinguished at present, bone marrow stimulation techniques and mosaicplasty techniques. The size of the lesion indicating the need for bone marrow stimulation as the required surgical procedure has recently been decreased (<1cm). The main objective of this study was therefore to evaluate the return to sport after OLTD surgery. Our hypothesis is that surgery of osteochondral lesions of the talar dome allows the resumption of sports activities in the majority of cases. Material and methodsThis multicenter prospective study was conducted across 10 French centers specializing in foot and ankle surgery. All patients aged 18 to 65 with symptomatic OLTD resistant to thorough medical treatment for at least 6 months, justifying surgery, were included from June 2018 to September 2019. In addition to the usual demographic data, the practice of sport and level (professional, competitive, leisure) were systematically investigated preoperatively. A common protocol for surgical management and postoperative follow-up had previously been established according to the arthrographic stage of the lesion. The most recent recommendations based on size, but also depth, were taken into account. The primary endpoint was return to sport. ResultsA final functional evaluation with the AOFAS (American Orthopedic Foot & Ankle Society) score was performed at a minimum of 12 months. Of 58 sports patients, 70.6% returned to sport (41/58) with an average delay of 4.3 months. A high AOFAS functional score (p=0.02) and a stage 1 lesion (p=0.006) were the only preoperative criteria significantly associated with a return to sport. No other factor was predictive of a return to sport. ConclusionOur prospective study shows that 70.6% of sports patients returned to sport after OLTD surgery according to a surgical protocol and standardized follow-up. Level of evidenceII.

Problema respectării drepturilor minoritîților naționale în activitățile politice ale reprezentanților ucrainenilor din Bucovina în anii 1928-1929

The death of King Ferdinand Ist and of the leader of the National Liberal Party I. I. C. Brătianu in 1927 laid the conditions for the change of power in Romania. The meeting in Alba-Iulia in May 1928 played an important role in the National Peasant Party coming to power, because the program of the party’s activities for the near future was announced there. After the government of I. Maniu came to power in November 1928, the representatives of the national minorities of Romania expected changes in the government's attitude towards the observance of the rights of national minorities, as well as the political regime liberalisation. The observance of the rights of national minorities for the Ukrainians of Bukovina was seen primarily in the return of the Ukrainian teaching language to the educational sphere adopted by the government. The resumption of activities was another issue after the abolition of the siege state in northern Bukovina, as well as Ukrainian educational societies, primarily the “Ruska Besida”, which performed tasks in educational activities through reading and amateur theatrical groups. The third issue, which should guarantee the implementation of the first two ones, was to obtain a sufficient number of seats in parliament for representatives of the Ukrainian community. From mid-October 1928 through February 1929, Ukrainian communities of Bukovina filed requests for teaching in Ukrainian. The newspaper “Chas” (Time) also dealt with this issue, publishing reports on the meeting of the communities. As a result, 199 applications were received with 30 thousand signatures, which gave the government grounds to talk about the possibility of introducing the corresponding number of teaching hours in schools of 139 communities. In general, the decision of the government in the field of teaching in the Ukrainian language was not made till December 1929 that caused concerns and statements from the Ukrainian side. Also, V. Zalozetskyi who was elected to the Senate in January 1929 made a statement about the loyalty of the Ukrainians of Bukovina to the authorities and motivated the need to introduce the Ukrainian language of teaching for Ukrainians. A number of statements concerning the need to study the state and Ukrainian languages in equal proportions was made by the communities. V. Zalozetskyi called the national consciousness of the Ukrainians of Bukovina not posing a threat to the Romanian statehood, but it could become a condition for preparing the intelligentsia for the future ‘non-Bolshevik Ukraine’. The restoration of the number of organizations of the “Ruska Besida” society led to the spread of the amateur theatre group activities. Such steps gave grounds, primarily to representatives of national liberals, to make statements about the demands of Ukrainians to remove the Romanian language from school. The active role in presenting the situation was played by the newspapers “Curentul” and “Universul”, describing the position and actions of national minorities too critically. In general, the Ukrainians turned out to be a very quiet minority comparing with the Hungarians’ protests and the situation in Dobrudja, although they were less organized to fight for the observance of their rights.

LAparoscopic Versus Abdominal hysterectomy (LAVA): protocol of a randomised controlled trial

IntroductionThere is uncertainty about the advantages and disadvantages of laparoscopic hysterectomy compared with abdominal hysterectomy, particularly the relative rate of complications of the two procedures. While uptake of laparoscopic hysterectomy...

Evidence and methods for a safe resumption of neuroscience activities at the time of COVID-19

Evidence and methods for a safe resumption of neuroscience activities at the time of COVID-19

Thermal characterization of Ajmer City: Insights into urban heat dynamics

Human development, urbanization, and ongoing environmental issues have led to environmental disturbances and climate changes in Ajmer, a crucial rest station for migrating birds. Congested and poorly planned urban areas, reduced vegetation cover, and increasing emissions from industries and automobiles all contribute to climate challenges. The rise in land surface temperature (LST) has led to the formation of urban heat islands (UHI). The goal of this research is to investigate UHI in Ajmer City, India. Using remotely sensed LANDSAT data and Geographic Information System (GIS), we analyzed LST and Normalized Difference Vegetation Index (NDVI) for the summer months (March to June) in Ajmer from 2015 to 2022, including the period when nationwide curfews were implemented due to Covid-19. The extraordinary measures taken to restrict human activities during the pandemic resulted in remarkable temporary declines in aerosols and atmospheric pollutants (NO2, CO, SO2, and PM) mainly due to restrictions on fossil fuel burning and transportation emissions. The analysis reveals that Urban LST was 312.07 K in 2019 and decreased to 308.228 K in 2020 due to the strict Covid-19 lockdowns. With the gradual easing of restrictions and resumption of human activities, LST slightly increased to 308.27 K in 2021 and further to 311.71 K in 2022. Researchers can now explore the effects of reduced surface vehicle heat and air pollution on LST and UHI intensity in Western Indian cities, providing valuable insights for urban planning and climate mitigation strategies.

The impact of COVID-19 vaccination on human mobility: The London case

The COVID-19 pandemic has become a global public health crisis, causing significant morbidity and mortality worldwide. As an early response, different lockdowns were imposed in the UK (and the world) to limit the spread of the disease. Although effective, these measures profoundly impacted mobility patterns across cities, significantly reducing the number of people commuting to work or travelling for leisure. As different governments introduced massive vaccination programs to tackle the pandemic, cities have significantly but slowly increased human mobility, enabling the resumption of travel, work, and social activities. Nevertheless, how much can this return to normal mobility patterns be attributed to vaccines? In this study, we answer this question using a statistical approach, analysing two different open urban mobility datasets to quantify the effect vaccination rollouts have had on increased human activities.

Fatigue-induced Landing Alterations in ACL Reconstructed Athletes after Return-to-Sport.

At the time of return-to-sport, anterior cruciate ligament reconstructed athletes still show altered neuromechanics in their injured leg during single leg hopping tasks. Part of these alterations can be magnified when these athletes are fatigued. So far, little is known whether fatigue-induced landing alterations persist after return-to-sport. Therefore, the aim of this study was to evaluate whether these alterations persist in the six months following return-to-sport. Sixteen anterior cruciate ligament reconstructed athletes performed five unilateral hop tasks before and after a fatigue protocol. The hop tasks were executed at three different time points (return-to-sport, 3 and 6 months post-return-to-sport). A 2-by-3 repeated measures ANOVA was performed to evaluate whether fatigue-induced landing alterations persisted 3 and 6 months following return-to-sport. At 6 months following return-to-sport, fatigue still induces a reduction in hamstring medialis activation and an increase in the knee abduction moment during a vertical hop with 90-degree inward rotation. Most fatigue-induced landing alterations present at the time of return-to-sport normalize after resumption of sports activities. However, a larger knee abduction moment in the injured leg after resumption of sports activities can still be observed.

Fibula Stress Fractures: A Systematic Review.

Fibula stress fractures are moderately common injuries among athletes and military recruits. Most of the available data for treatment come from case reports with a limited number of large studies. This systematic review aims to evaluate and present the current literature on fibula stress fractures to help set evidence-based goals and establish realistic expectations for return to activity and sport in injured patients. Systematic literature search using 3 databases. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) protocol and the Cochrane Handbook guidelines were followed. The terms "fibula stress fracture" or "fibular stress fracture" were searched. Date range for inclusion was 2010-2022. Pediatric, non-English, lack of full text available, and studies lacking differentiating fibula stress fracture versus other types of fractures in their data were excluded. A total of 3 studies with 10 987 subjects were included. Among 521 stress fractures in all 3 studies, there were 45 (8.6% of all fractures) cases involving the fibula. All fibular stress fractures healed successfully with nonoperative measures and non-weight-bearing precautions, on average, by 7 weeks and patients resumed activity, on average, by 9 weeks. Among the 3 studies, there were no reported cases of nonunion or delayed union. This review found that fibula stress fractures have a relatively moderate incidence among stress fracture injuries with a frequency up to 8.6%. Despite this high number, there is sufficient healing in fibula stress fractures when managed nonoperatively with activity modification in a weight-bearing foot to allow for resumption of baseline activities, on average, by 9 weeks. This review can be used to help set evidence-based goals and establish realistic expectations for return to activity and sport in patients who suffer from fibula stress fractures. Level II.

Comparative study between stapled and open hemorrhoidectomy results with one-year follow-up

Background Hemorrhoids are one of the most prevalent diseases of mankind, affecting 4%–36% of the general population. Most patients are asymptomatic. Anal bleeding during the act of defecation is the most common presenting symptom. Many techniques were described for treatment, including stapled hemorrhoidectomy and conventional (open) ones. Objective The objective is to compare the effectiveness, short-term outcomes, and postoperative complications of stapled hemorrhoidopexy against open hemorrhoidectomy in the treatment of symptomatic primary piles. Methods A total of 76 patients were operated on at Al-Azhar University Hospital. They were divided into two equal groups: the stapled group (operated using a proximate PPH hemorrhoidal stapler of 33 mm) and the open group. All patients were followed for 1 year. Preoperative complaints, operative time and blood loss, postoperative pain, complications, and resumption of daily activities were recorded for both groups. Results Intraoperative blood loss and duration of operation were less in the stapler group. Postoperative bleeding, postoperative pain, and discomfort were less in the stapler group, with a significant difference from the open group. Healing and resumption of daily activities were faster in the stapler group. Regarding early recurrence, it happened in two cases in the stapler group and in the open group as well. There are no differences between both groups regarding urine retention. Anal incontinence did not happen in both groups. Mild anal stenosis occurred in one case in every group and occurred late. Conclusion Stapled hemorrhoidectomy is a promising procedure with less pain, a shorter duration of hospital stay, and a faster resumption of daily activity than open hemorrhoidectomy. However, long-term follow-up for many years is still needed to define the recurrence rate in stapled hemorrhoidectomy.

Review of Surgical Management Techniques for Osteochondral Lesions.

Early attempts at surgical management of cartilage lesions date back to the 1950s. Since then, various reconstructive techniques have been developed; unfortunately, none of the methods used has been able to produce a regenerate formed solely of hyaline cartilage. This paper summarizes the most popular techniques for chondral and osteochondral reconstructions of knee joint tissues.The techniques differ in their indications, which depend primarily on the location of the injury, the extent of the damage and the patient's overall health. In cases of deep damage, osteochondral reconstruction is indicated, which involves both repairing the bone defect and creating favorable conditions for the formation of regenerative tissue cartilage.The use of an appropriate repair technique increases the chances of a good therapeutic effect, which is understood as a reduction in pain, resumption of previous activities and slowing down the progression of osteoarthritis.

Eye Movement Desensitization and Reprocessing Therapy in Chronic Fatigue Syndrome: A Single-Case Experiment Testing the Effect on Persistent Negative Evaluation of Fatigue

Background:While cognitive behavioral therapy (CBT) for chronic fatigue syndrome or myalgic encephalomyelitis (CFS/ME) can lead to the normalization of fatigue levels and resumption of activities, a subgroup of patients still evaluates fatigue negatively.Objective:The objective was to investigate whether eye movement desensitization and reprocessing (EMDR) therapy leads to a less negative evaluation of fatigue.Method:This was a randomized single-case experimental study. Five CFS/ME patients (all female, mean age of 35 years), who had completed CBT but still evaluated fatigue negatively, received EMDR therapy. The primary outcome, that is, negative evaluation of fatigue, was assessed daily (three items, e.g., “My fatigue is frustrating”). During EMDR therapy sessions, distress in response to a selected image was measured. Clinical assessments were performed before, directly after, and one month after EMDR therapy.Results:During EMDR therapy sessions, all patients reported high distress related to memories of having CFS/ME. EMDR therapy led to a reduction in this distress. Daily measured negative evaluations of fatigue declined in three patients, albeit not significantly. Three of five patients showed clinically relevant improvement in evaluations of fatigue on clinical pre-/post measures.Conclusion:EMDR therapy can reduce emotional distress associated with fatigue, but it is unclear whether it can change its negative evaluation.

The COVID-19 green certificate’s effect on vaccine uptake in French and Italian regions

The COVID-19 green certificates were introduced in many countries in 2021 to encourage vaccine uptake against the COVID-19 virus in order to reduce the spread of severe infection among the population, ensure the safety of cross-border movements, and facilitate the resumption of social life and economic activities. This study uses a single-group interrupted time series approach to examine the effect of the green certificate announcement on the first doses of the COVID-19 vaccine in 20 Italian and 18 French regions during the summer of 2021. The estimation results show that the green certificate announcement mitigated regional disparities in vaccine uptake. It persuaded undecided people to have their first doses of the COVID-19 vaccine, especially in regions lagging in the mass vaccination campaign. It was less effective in those regions where there was already a high level of vaccine protection. The announcement also proved to be an effective political strategy with which to increase the first-dose rates immediately, but not in the long term.

An Epidemiological Analysis for Assessing and Evaluating COVID-19 Based on Data Analytics in Latin American Countries.

This research provides a detailed analysis of the COVID-19 spread across 14 Latin American countries. Using time-series analysis and epidemic models, we identify diverse outbreak patterns, which seem not to be influenced by geographical location or country size, suggesting the influence of other determining factors. Our study uncovers significant discrepancies between the number recorded COVID-19 cases and the real epidemiological situation, emphasizing the crucial need for accurate data handling and continuous surveillance in managing epidemics. The absence of a clear correlation between the country size and the confirmed cases, as well as with the fatalities, further underscores the multifaceted influences on COVID-19 impact beyond population size. Despite the decreased real-time reproduction number indicating quarantine effectiveness in most countries, we note a resurgence in infection rates upon resumption of daily activities. These insights spotlight the challenge of balancing public health measures with economic and social activities. Our core findings provide novel insights, applicable to guiding epidemic control strategies and informing decision-making processes in combatting the pandemic.

After the first lockdown due to the COVID-19 pandemic: Perceptions, experiences, and effects on well-being in Italian people.

Since the COVID-19 pandemic and the subsequent measures of containment, multiple studies have been conducted aimed at assessing the impacts on people's psychophysical well-being; however, few studies have investigated the general population's perceptions, experiences, and effects by adopting a mixed-method approach. A total of 855 Italian participants completed an online survey, conducted in the period following the first lockdown in Italy. Psychological well-being, perceived stress and COVID-19-related fears were assessed by standardized questionnaires (Psychological General Well-Being Index-Short version, Perceived Stress Scale 10, and Multidimensional Assessment of COVID-19-Related Fears). The process of sense-making of the experience during the lockdown period was also evaluated by means of an open-ended question. Participants reported a lower level of general well-being, and a higher level of both perceived stress and COVID-19-related fear during the lockdown period compared to the time of the survey (1 month after the resumption of activities). The thematic analysis of responses to the open-ended question revealed two factors and five clusters, which explain the thematic variance among the narratives: the first factor refers to the type of experience (emotional states and feelings vs. objective descriptions of daily activities), while the second concerns positive or negative connotations of the experiences reported. This study explored the psychological impact of the first lockdown on people's well-being, and described the process of making sense of the experience during the lockdown 1 month after going back to previous habits. Results highlighted the effectiveness of the mixed-method approach for an in-depth and exhaustive investigation of people's psychological condition during and after the first lockdown.

An Inappropriate Rise in NO2 During the COVID-19 Pandemic in the Urban Area of Chhattisgarh, India

The COVID-19 first case was reported in India on January 30, 2020, and in Chhattisgarh on March 19, 2020, and since then a sharp surge has been noticed. The government of India imposed a nationwide lockdown on March 25, 2020, a complete suspension of human activities, viz., industry, construction, transport, academic institutions, etc., which resulted in an improvement in air quality (a decrease in PM2.5 and PM10, alteration in NO2 and an increase in O3). But the rate of cases of COVID-19 has increased sharply, and eventually, under economic pressure, the lockdown was withdrawn on June 1, 2020, which further accelerated the exponential growth of COVID-19 cases. We noticed that in the Chhattisgarh State of India, the alteration in the air quality index during the lockdown period is continuing even after the restoration of anthropogenic activities. Among PM2.5, PM10, NO2, and O3, the behavior of NO2 was found to be different than others; it was found to increase during the lockdown period but further decreased with the resumption of anthropogenic activities. We conclude that the air quality index has an insignificant impact on COVID-19 infection.

Access and adherence to the most recent recommendations regarding resumption of activities after a mild traumatic brain injury

ABSTRACT Objectives 1) To examine access and adherence to the Berlin (2016) recommendations for resuming physical and intellectual activities after mild traumatic brain injury (mTBI) (including an exploration of barriers and facilitators). 2) To assess post-mTBI symptoms in relation to recommendation adherence. Method 73 participants who sustained a mTBI completed an online survey with questions about access and adherence to recommendations and validated measures of symptoms. Results Almost all participants had received recommendations from a health professional after their mTBI. Two thirds of recommendations reported had at least moderate correspondence with the Berlin (2016) recommendations. The vast majority of participants reported weak or partial adherence to these recommendations and only 15.7% reported complete adherence. Overall, adherence to recommendations explained a significant portion of the variance in the severity and number of unresolved post-mTBI symptoms. The most common barriers were: being in a critical period for school or work, pressure to return to work or school, screen use, and presence of symptoms. Conclusions Sustained efforts are required to disseminate appropriate recommendations after mTBI. Clinicians should support patients in eliminating barriers to recommendation adherence, as greater adherence may facilitate recovery.