The "unknown territory" of goal-setting: Negotiating a novel interactional activity within primary care doctor-patient consultations for patients with multiple chronic conditions.

Goal-setting is widely recommended for supporting patients with multiple long-term conditions. It involves a proactive approach to a clinical consultation, requiring doctors and patients to work together to identify patient’s priorities, values and desired outcomes as a basis for setting goals for the patient to work towards. Importantly it comprises a set of activities that, for many doctors and patients, represents a distinct departure from a conventional consultation, including goal elicitation, goal-setting and action planning. This indicates that goal-setting is an uncertain interactional space subject to inequalities in understanding and expectations about what type of conversation is taking place, the roles of patient and doctor, and how patient priorities may be configured as goals. Analysing such spaces therefore has the potential for revealing how the principles of goal-setting are realised in practice. In this paper, we draw on Goffman’s concept of ‘frames’ to present an examination of how doctors’ and patients’ sense making of goal-setting was consequential for the interactions that followed. Informed by Interactional Sociolinguistics, we used conversation analysis methods to analyse 22 video-recorded goal-setting consultations with patients with multiple long-term conditions. Data were collected between 2016 and 2018 in three UK general practices as part of a feasibility study. We analysed verbal and non-verbal actions for evidence of GP and patient framings of consultation activities and how this was consequential for setting goals. We identified three interactional patterns: GPs checking and reframing patients’ understanding of the goal-setting consultation, GPs actively aligning with patients’ framing of their goal, and patients passively and actively resisting GP framing of the patient goals. These reframing practices provided “telling cases” of goal-setting interactions, where doctors and patients need to negotiate each other’s perspectives but also conflicting discourses of patient-centredness, population-based evidence for treating different chronic illnesses and conventional doctor-patient relations

A new method to identify key match-play behaviours of young soccer players: Development of the Hull Soccer Behavioural Scoring Tool

The aim of this research was to assess the validity and reliability of a newly developed scoring tool, designed for monitoring youth soccer players during match-play performance to support coaches/scouts with the talent identification process. The method used to design the Hull Soccer Behavioural Scoring Tool comprised of a five-stage process of (i) conducting an initial literature review to establish content validity (ii) gaining content validity through a cross sectional online survey (iii) establishing face validity via expert coach feedback (iv) conducting inter-rater reliability tests and (v) intra-rater reliability tests. In stage two, twenty-two soccer academy practitioners completed an online survey, which revealed that player behaviours such as resilience, competitiveness, and decision making were all valued as the most important behavioural characteristics by practitioners (90.9%), whilst X-factor was valued as least important by a significant amount (27.2%). Stages three to five of the testing procedure included a sample of four academy coaches not involved in the preceding stages. Twenty male collegiate soccer players (under-16 to under-18) involved in the study took part in four versus four small-sided games (SSG) in a ‘round-robin’ tournament across three weeks which accumulated 14 SSG’s, 100 – 140 minutes of playing time and 70 – 98 individual player grades. Two of the four academy coaches watched the SSG’s and used the Hull Soccer Behavioural Scoring Tool to assess live evidence of desirable player behaviours, which was subsequently followed by retrospective video analysis for intra-rater reliability testing. The remaining two academy coaches watched the same SSG retrospective video footage to test for inter-rater reliability. Reliability results revealed an acceptable level of agreement with scores between 81.25% - 89.9% for inter-rater whilst intra-rater provided scores between 80.35% - 99.4%. Preliminary evidence here suggests that the Hull Soccer Behavioural Scoring Tool is both a valid and reliable method to assess desirable player behaviours during talent identification processes. Thus, youth soccer practitioners and researchers should seek to test and further validate the tool in order to confirm its utility as a means of measuring behavioural characteristics of youth soccer players

Soccer academy practitioners’ perceptions and application of bio-banding

The primary aims of this study were to examine the application of maturity status bio-banding within professional soccer academy programmes and understand the methods employed, the intended objectives, and the potential barriers to bio-banding. Using a mixed method design, twenty-five professional soccer academy practitioners, completed an online survey designed to examine coaches perceived influence of maturation on practice, perceptions of bio-banding, their application of bio-banding and their perceived barriers to bio-banding implementation. Seven participants who had experience with, or knowledge of, the bio-banding process within an academy youth soccer setting were recruited to complete a semi-structure interview and the interview schedule was informed by common themes within the survey data. Frequency and percentages of responses for individual items were calculated. Interview data was transcribed and were analysed using a directed approach to content analysis with combination of inductive and deductive approaches being used to identify meaning units which were subsequently grouped together to form emergent categories (lower-order themes) based on their similarity to each other and distinction from other categories. The main findings were that (1) there is consensus among the practitioners that the individual effect of maturation impacts their ability to accurately assess the soccer competencies, (2) the majority (80%) of the sample had implemented bio-banding, with practitioners showing a clear preference for using the Khamis and Roche method to bio-band players, with the greatest perceived benefit being during maturity-matched formats, specifically for late or post-PHV players, (3) Practitioners perceived that bio-banding enhances their ability to assess academy soccer players, and (4) practitioners who have used bio-banding believe that the method is an effective way of enhancing the perception of challenge, and provides psycho-social benefits. For the implementation of bio-banding to succeed, a collaborative approach to its implementation should be taken to permit the successful embedment of bio-banding within the typical training schedules across the adolescent phase of the player development pathway

Monitoring practices of training load and biological maturity in UK soccer academies

Purpose: Overuse injury risk increases during periods of accelerated growth, which can subsequently impact development in academy soccer, suggesting a need to quantify training exposure. Nonprescriptive development scheme legislation could lead to inconsistent approaches to monitoring maturity and training load. Therefore, this study aimed to communicate current practices of UK soccer academies toward biological maturity and training load. Methods: Forty-nine respondents completed an online survey representing support staff from male Premier League academies (n = 38) and female Regional Talent Clubs (n = 11). The survey included 16 questions covering maturity and training-load monitoring. Questions were multiple-choice or unipolar scaled (agreement 0-100) with a magnitude-based decision approach used for interpretation. Results: Injury prevention was deemed highest importance for maturity (83.0 [5.3], mean [SD]) and training-load monitoring (80.0 [2.8]). There were large differences in methods adopted for maturity estimation and moderate differences for training-loadmonitoring between academies. Predictions of maturity were deemed comparatively low in importance for bio-banded (biological classification) training (61.0 [3.3]) and low for bio-banded competition (56.0 [1.8]) across academies. Few respondents reported maturity (42%) and training load (16%) to parent/guardians, and only 9% of medical staff were routinely provided this data. Conclusions: Although consistencies between academies exist, disparities in monitoring approaches are likely reflective of environment-specific resource and logistical constraints. Designating consistent and qualified responsibility to staff will help promote fidelity, feedback, and transparency to advise stakeholders of maturity-load relationships. Practitioners should consider biological categorization to manage load prescription to promote maturity-appropriate dose-responses and to help reduce the risk of noncontact injury

Bending moments in long spines

While it is unusual to test tank-models with controlled, variable elasticity there are several reasons why we believe that it is im-portant to exert the large effort required. 1. The convenient model-building materials are much too stiff to represent the proper behaviour of concrete and steel at full scale. 2. We believe that, although the close-packed, crest-spanning ter-minator configuration is the best possible arrangement for a wave-energy device, it is not economic to resist bending moments great-er than those which would occur at the power limit. This means that non-destructive yielding to bigger waves must be achieved. This will not only save money on the spine structure but will also produce dramatic reductions in mooring forces. 3. Work in the narrow tank had shown that the correct control of a duck mounting could produce large improvements in duck perfor-mance, doubling the efficiency in waves twenty-five duck diameters in length. We had also discovered that the best values of mounting stiffness were low, less than those that would be provided by post-tensioned concrete at full scale, and that the mounting move-ment could itself be a useful power-generating mechanism. Further-more the hardware needed to provide non-destructive yielding needed very little modification to provide intelligent control and the extra generating capability. We realised that the software require-ments would be formidable - well beyond our present knowledge. But we were confident that the existence of a controlled model would, as so often before, stimulate theoretical work. Furthermore we were quite certain that the progress of computer technology be-tween now and the date of the return of energy shortage would be so enormous that any level of control sophistication could be safe-ly assumed to be available at virtually zero cost. On many occa-sions it has seemed that this view was not shared by the civil and marine engineers who assess our progress. The work reported in this volume covers the measurements of bending moments and joint angles as a function of sea conditions, model lengths and stiffness, for circular spine sections without ducks. Other volumes will contain the observations of shear, axial, torsion and mooring forces, for spines with various appendages

Relationships of internal and external training load in elite-level adolescent soccer

Introduction and Purpose: The quantification of locomotive demands such as high-speed running (>13 kmh-1) are now commonplace within the monitoring of external training load metrics. However, limitations linked to discounting energetically demanding changes in running speed and lack of sensitivity between individual locomotor profiles raise concerns over the accuracy of this variable (1). Recent findings have identified tri-axial accelerometer data to be an effective measure of movement efficiency and that it could be a more suitable measure of external training load than locomotive demands alone (1, 2). It is also becoming increasingly common that practitioners seek quantification of the physiological responses to these external training loads, referred to as internal training load (such as heart rate and rating of perceived exertion [RPE]) (2). Combining external and internal training load variables has been shown to provide a more useful approach than using either independently as this permits a better understanding of the dose-response of activity (2, 3). Therefore, the aim of this study was to observe the magnitude of associations between internal and external training load amongst elite-level adolescent soccer players. Methods: Thirty-four male adolescent soccer players (Age: 13.85 ± 1.02 yrs; Weight: 55.1 ± 12.8 kg; Height: 166.9 ± 10.3 cm) from the same category one academy were monitored over a two-week training period. High-resolution tri-axial accelerometers using a vector-magnitude algorithm (PlayerLoadTM), high-intensity distance (HID) (MinimaxX v4.0, Catapult InnovationsTM, Melbourne, Australia) and session RPE (sRPE; CR10) (15 mins post training) were collected from three training sessions per player. From this, RPELoad was calculated using training session duration (mins) multiplied by sRPE. Between-subject correlations were used to determine relationships using a standardised scale of magnitudes. Results: The relationship between RPELoad and PlayerLoadTM was moderate (r = 0.41; 90% confidence interval 0.14 to 0.62), small for sRPE and PlayerLoadTM (r = 0.22; -0.07 to 0.48), and trivial for sRPE and HID (r = 0.12; -0.17 to 0.39) and RPELoad and HID (r = 0.07; -0.22 to 0.35). Conclusions: The strongest associations between internal and external training load in adolescent soccer exist between RPELoad and PlayerLoadTM. Both sRPE and RPELoad have a limited association with HID. This suggests that tri-axial accelerometer data combined with post-activity perceived exertion ratings may offer a better indicator of the dose-response than high-speed locomotor metrics. However, due to the relatively trivial overall associations, it is advised that where possible practitioners routinely monitor a combination of both external training load (i.e., PlayerLoadTM and HID) alongside internal RPELoad to inform training load monitoring