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      Athlete Enjoyment of Prior Education Moderates change in Concussion-Reporting Intention after Interactive Education

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          Abstract

          Undiagnosed concussions increase risk of additional injuries and can prolong recovery. Because of the difficulties recognizing concussive symptoms, concussion education must specifically target improving athlete concussion reporting. Many concussion education programs are designed without significant input from athletes, resulting in a less enjoyable athlete experience, with potential implications on program efficacy. Athlete enjoyment of previous concussion education programs moderates the improvement in concussion-reporting intention after experiencing the research version of CrashCourse (CC) concussion education. Prospective cohort study. Level of evidence: Level IV. Quantitative assessment utilizing ANOVA with moderation analysis of 173 male high school football players, aged 13 to 17, who completed baseline assessments of concussion knowledge, concussion reporting, and attitudes about prior educational interventions. Athletes were subsequently shown CC, before a follow-up assessment was administered assessing the same domains. At baseline, only 58.5% of athletes reported that they enjoyed their previous concussion education. After CC, athletes were significantly more likely to endorse that they would report a suspected concussion (from 69.3% of athletes to 85.6%; P < .01). Enjoyment of previous concussion education moderated concussion-reporting intention after CC ( P = .02), with CC having a greater effect on concussion-reporting intention in athletes with low enjoyment of previous concussion education ( b = 0.21, P = .02), than on individuals with high enjoyment of previous concussion education ( P = .99). Enjoyment of CC did not have a moderating effect on concussion-reporting intention. Athletes who previously did not enjoy concussion education exhibited greater gains in concussion-reporting intention than athletes who enjoyed previous education. Given the potential risks associated with undiagnosed concussions, concussion education has sought to improve concussion reporting. Because most athletes participate in concussion education programs due to league or state mandates, improving concussion-reporting intention in these low-enjoyment athletes is of particular relevance to improving concussion-reporting intention broadly.

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          The new neurometabolic cascade of concussion.

          Since the original descriptions of postconcussive pathophysiology, there has been a significant increase in interest and ongoing research to study the biological underpinnings of concussion. The initial ionic flux and glutamate release result in significant energy demands and a period of metabolic crisis for the injured brain. These physiological perturbations can now be linked to clinical characteristics of concussion, including migrainous symptoms, vulnerability to repeat injury, and cognitive impairment. Furthermore, advanced neuroimaging now allows a research window to monitor postconcussion pathophysiology in humans noninvasively. There is also increasing concern about the risk for chronic or even progressive neurobehavioral impairment after concussion/mild traumatic brain injury. Critical studies are underway to better link the acute pathobiology of concussion with potential mechanisms of chronic cell death, dysfunction, and neurodegeneration. This "new and improved" article summarizes in a translational fashion and updates what is known about the acute neurometabolic changes after concussive brain injury. Furthermore, new connections are proposed between this neurobiology and early clinical symptoms as well as to cellular processes that may underlie long-term impairment.
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            The epidemiology of sport-related concussion.

            Concussions and head injuries may never be completely eliminated from sports. However, with better data comes an improved understanding of the types of actions and activities that typically result in concussions. With this knowledge can come improved techniques and rule changes to minimize the rate and severity of concussions in sports. This article identifies the factors that affect concussion rate. Copyright © 2011 Elsevier Inc. All rights reserved.
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              Factors Determining the Behavioral Intention to Use Mobile Learning: An Application and Extension of the UTAUT Model

              This study developed and empirically tested a model to predict the factors affecting students’ behavioral intentions toward using mobile learning (m-learning). This study explored the behavioral intention to use m-learning from the perspective of consumers by applying the extended unified theory of acceptance and use of technology (UTAUT) model with the addition of perceived enjoyment, mobile self-efficacy, satisfaction, trust, and perceived risk moderators. A cross-sectional study was conducted by employing a research model based on multiple technology acceptance theories. Data were derived from an online survey with 1,562 respondents and analyzed using structural equation modeling. Partial least squares (PLS) regression was used for model and hypothesis testing. The results revealed that (1) behavioral intention was significantly and positively influenced by satisfaction, trust, performance expectancy, and effort expectancy; (2) perceived enjoyment, performance expectancy, and effort expectancy had positive associations with behavioral intention; (3) mobile self-efficacy had a significantly positive effect on perceived enjoyment; and (4) perceived risk had a significantly negative moderating effect on the relationship between performance expectancy and behavioral intention. Our findings correspond with the UTAUT model and provide a practical reference for educational institutions and decision-makers involved in designing m-learning for implementation in universities.
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                Author and article information

                Journal
                Inquiry
                Inquiry
                INQ
                spinq
                Inquiry: A Journal of Medical Care Organization, Provision and Financing
                SAGE Publications (Sage CA: Los Angeles, CA )
                0046-9580
                1945-7243
                31 May 2021
                Jan-Dec 2021
                : 58
                : 00469580211022641
                Affiliations
                [1 ]Harvard Medical School, Boston, MA, USA
                [2 ]Massachusetts General Hospital, Boston, MA, USA
                [3 ]Spaulding Rehabilitation Hospital, Boston, MA, USA
                [4 ]Boston University School of Medicine, Boston, MA, USA
                [5 ]University of Colorado Denver Anschutz Medical Campus, Aurora, CO, USA
                [6 ]University of Colorado School of Medicine, Aurora, CO, USA
                [7 ]Stanford School of Medicine, Palo Alto, CA, USA
                [8 ]Stanford University, Stanford, CA, USA
                [9 ]Emerson Hospital, Concord, MA, USA
                [10 ]University of Texas Southwestern Medical Center, Dallas, TX, USA
                [11 ]Brigham and Women’s Hospital, Boston, MA, USA
                Author notes
                [*]Daniel H. Daneshvar, Harvard Medical School, 300 First Avenue, Boston, MA 02129, USA. Email: ddaneshvar@ 123456mgh.harvard.edu
                Author information
                https://orcid.org/0000-0003-3691-9513
                https://orcid.org/0000-0002-9340-6338
                https://orcid.org/0000-0003-4377-8245
                Article
                10.1177_00469580211022641
                10.1177/00469580211022641
                8170270
                34053328
                d159ebd2-b497-4a5c-8e92-f199b8645362
                © The Author(s) 2021

                This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License ( https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page ( https://us.sagepub.com/en-us/nam/open-access-at-sage).

                History
                : 12 February 2021
                : 28 April 2021
                : 13 May 2021
                Funding
                Funded by: Stanford University, FundRef https://doi.org/10.13039/100005492;
                Categories
                Original Research
                Custom metadata
                January-December 2021
                ts1

                concussion,traumatic brain injury,education,enjoyment,knowledge

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